AN ALGORITHMIC APPROACH TO ASPERGILLUS SINUSITIS

The effective management of paranasal sinus aspergillosis requires ear ly diagnosis, histological classification, surgery-and where appropria te, chemotherapy. Fungal sinusitis may be easily missed unless a high index of suspicion is maintained and specific culture and histology re quested. The disease is classified into invasive and noninvasive types , each being divided into two subgroups: invasive aspergillosis may be either fulminant or indolent and noninvasive disease localized or all ergic. The literature is reviewed and an algorithmic approach to asper gillus sinusitis proposed. The importance of histologically differenti ating invasive from noninvasive aspergillosis prior to selecting the a ppropriate treatment options is stressed. CT scan should precede defin itive surgery, and be used in follow-up. Close and prolonged follow-up is essential.