A Prospective Clinical Study on Types and Diagnostic Criteria of Fungal Rhinosinusitis used in Tertiary Teaching Hospital of Telangana
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 6
Abstract
Background: Fungal rhinosinusitis (FRS) is a disease of a wide spectrum of immune and pathological responses and includes invasive, chronic, granulomatous, and allergic variants. Consensus on its terminology, pathogenesis, and optimal management is not uniform among the surgeons. Based on the criteria of the International Society for Human and Animal Mycology, a clinical study was conducted on FRS. Aim of the Study: The aim is to study and determine clinically and radiologically the various types of FRS and analyze them with the help of laboratory tests for confirmation in a clinical setting. Materials and Methods: A total of 237 patients with FRS were included, and a detailed clinical history, demographic data, clinical examination, and direct sinonasal endoscopy were done. Radiological evaluation was done and the findings considered were air-fluid levels, opacities, mucosal thickening, and sinus wall erosion; expansion of the sinus walls, variegated densities, and other sinuses involved were studied. Fungal studies and histopathological studies were done. Treatment given to all the patients was recorded, and all the patients were followed up for 12 months. All the data were analyzed using standard statistical methods. Observations and Results: Among the 237 consecutive patients included, there were 144 males (60.75%) and 93 females (39.24%). The mean age in males was 37.62 ± 4.73 years, and in females, it was 39.18 ± 3.64 years. 69/237 (29.11%) belonged to 33–42 years, 53/237 (22.36%) belonged to 23–32 years, 35/237 (14.76%) patients to 13–22 years, 23/237 (9.70%) patients to 53–62 years, and 20/237 (8.43%) patients to 63–72 years age group. Construction workers were 29/23 (12.23%), factory workers were 45/237 (19.40%), agriculture workers were 50/237 (21.09%), students were 23/237 (9.70%), office-goers were 50/237 (21.09%), and homemakers were 40/237 (16.87%) in number. Allergy was present in 94/237 (39.66%) and bronchial asthma in 52 (21.94%) patients. Diabetes mellitus was present in 44/237 (18.56%), tuberculosis in (6.32%), previous surgeries in 74 (31.22%), malignancies in 21 (8.86%), and psychiatric illnesses in 32 (13.50%) patients. Conclusions: The diagnosis of FRS is challenging due to its wide spectrum of clinical symptoms and signs. Radiological features such as hyperattenuation, neo-osteogenesis, air-fluid level, bone erosion, and extra sinus extension are the parameters that will help routinely assess and differentiate fungal sinusitis from non-fungal sinusitis with considerable accuracy. Thorough clinical history, clinical examination, and laboratory evaluation hold the key to successful provisional diagnosis. Post-treatment assessment in India is difficult due to non-availability of patients for follow-up.
Authors and Affiliations
M Ravi Kumar, B Vijaykumar
Keywords
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