Paranasal sinus mycoses in north India

Recognizing the high incidence of paranasal sinus mycoses in north India, w e analysed retrospectively the clinical, mycological and management aspects of 178 patients with proven disease attending our institute. On the basis of clinical, radiological, histopathological and mycological findings, the patients could be categorized into those with allergic (8), non-invasive (9 2) and invasive (78) disease types. Bony erosion without mucosal invasion b y fungi was seen in 16 patients with non-invasive disease. Young men from r ural areas were the most commonly affected. Rhinorrhoea with nasal polyposi s (45.8%) and proptosis (46.4%) was the most common presentation. Concurren t involvement of the maxillary and ethmoid sinuses was common in these pati ents, whereas isolated sphenoid and frontal sinuses were involved in the in vasive variety only. Orbital and intracranial extensions were detected in 1 00% and 13.2%, respectively, of patients with the invasive type of disease. Aspergillus flavus (79.7%) was the most common isolate. Surgical debrideme nt and sinus ventilation were adequate for the effective management of the non-invasive disease. However, adjuvant medical therapy was included in tre atment of the semi-invasive and invasive varieties of the disease. Itracona zole was found to be most useful in prevention of recurrence in the invasiv e type, Mortality was highest (33.3%) among patients with zygomycotic infec tion. Invasive fungal granuloma with orbital and intracranial invasion is a distinct entity in terms of its clinical course and treatment compared wit h noninvasive fungal sinusitis, and it needs to be treated aggressively wit h surgical excision and postoperative itraconazole.