THE ROLE AUF ENDONASAL SURGERY IN CHRONIC FUNGAL SINUSITIS

Many host factors even in immunocompetent patients may have an influen ce on development of a fungal diseases within the paranasal sinuses. F ungal sinusitis can occur in an acute form or more often to a chronic type of the disease. These mainly relatively asymptomatic chronic form s are further divided into a chronic noninvasive, chronic allergic, an d chronic invasive disease. Endonasal microsurgery has significantly c hanged the management of chronic fungal sinusitis and allows adequate removal of pathologic tissue even in advanced situations. The aim of t his study was to analyze the efficacy of endonasal surgery in chronic fungal sinusitis. Material and Methods: In a retrospective study we as sessed a group of 40 patients who had endonasal surgery for chronic fu ngal sinusitis. Patient records, CT and MRI scans, microbiology and hi stology as well as the postoperative clinical follow-up including endo scopic photo documentation were evaluated over a period of 5 years. Al l patients underwent endonasal surgery using endoscopic techniques. Th e microscope was of additional help in a few cases with extended disea se and multiple dehiscences of the skull base. Results: Twenty-four pa tients had a chronic noninvasive of fungal sinusitis and 16 patients h ad a chronic invasive form. All these patients underwent endonasal sur gery without external incision. The fungal disease was erradicated in 39 cases, and revision surgery was required in only one case in which involvement of the contralateral side was not initially detected. In t wo cases scar tissue in the middle meatus was later excised but withou t evidence of residual fungal disease. Only in 6 cases was antifungal chemotherapy required, where the disease had spread into surrounding t issue or the patient had severe symptoms. Conclusions: Endonasal micro surgical techniques are today the appropriate approach for managing ch ronic fungal sinus disease even in severe cases with radiologic eviden ce of expansion or invasion of surrounding tissue. Additional antifung al chemotherapy is only rarely indicated, specifically when the fungal disease invades surrounding tissue.