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Chronic aspergillosis of paranasal sinus — Clinical Guidelines

Overview

Chronic aspergillosis of the paranasal sinuses is a persistent fungal infection typically caused by Aspergillus species, leading to destructive lesions and often requiring prolonged antifungal therapy and surgical intervention when medical management fails 1.

Diagnosis

Imaging: High-resolution CT scans are essential for detailed evaluation of paranasal sinus involvement, including assessing extent and complications 3.

Histopathology: Biopsy confirmation is crucial for definitive diagnosis, identifying characteristic fungal elements 1.

Preoperative Planning: Meticulous evaluation of CT scans using advanced DICOM viewers with multiplanar reconstruction (MPR) capabilities can enhance surgical planning 2.

Management

First-Line Treatment: Antifungal therapy, typically with itraconazole or voriconazole, is initiated 1.

Adjunctive Surgical Intervention: Endoscopic medial maxillectomy (EMM) may be required for refractory cases to remove necrotic tissue and fungal masses 1.

Navigation Systems: Utilization of image-guided navigation systems during surgery can improve precision and reduce complications 4 6 7.

Special Populations

Elderly: No specific guidelines provided in the abstracts; however, careful consideration of comorbidities and surgical risks is advised 1.

Comorbidities: Patients with underlying immunodeficiencies require tailored antifungal regimens and closer monitoring 1.

Key Recommendations

Utilize high-resolution CT scans with advanced imaging software for preoperative assessment to optimize surgical planning and reduce complications (Evidence: Moderate 2 3).

Initiate treatment with voriconazole or itraconazole for chronic aspergillosis, adjusting based on patient-specific factors and response (Evidence: Moderate 1).

Consider image-guided surgical techniques during endoscopic interventions to enhance precision and minimize risks (Evidence: Moderate 4 6 7).

References

1 Witkowska A, Szczygielski K, Jurkiewicz D. Endoscopic medial maxillectomy in patients treated at the Otorhinolaryngology and Laryngological Oncology Clinic of Military Institute of Medicine in Warsaw in the years 2008-2018. Otolaryngologia polska = The Polish otolaryngology 2020. link 2 Frączek M, Kolator M, Kręcicki T. The usefulness of free dicom viewers in rhinologic practice. Wiadomosci lekarskie (Warsaw, Poland : 1960) 2016. link 3 Mistry SG, Strachan DR, Loney EL. Improving paranasal sinus computed tomography reporting prior to functional endoscopic sinus surgery - an ENT-UK panel perspective. The Journal of laryngology and otology 2016. link 4 Stelter K, Ertl-Wagner B, Luz M, Muller S, Ledderose G, Siedek V et al.. Evaluation of an image-guided navigation system in the training of functional endoscopic sinus surgeons. A prospective, randomised clinical study. Rhinology 2011. link 5 Whiteside OJ, Corbridge RJ, Capper JW. Esme Hadfield (1921-92) and the Wycombe woodworkers. Journal of medical biography 2010. link 6 Parikh SR, Fried MP. Navigational systems for sinus surgery: new developments. The Journal of otolaryngology 2002. link 7 Gunkel AR, Freysinger W, Martin A, Völklein C, Bale RJ, Vogele M et al.. Three-dimensional image-guided endonasal surgery with a microdebrider. The Laryngoscope 1997. link 8 Hill DL, Langsaeter LA, Poynter-Smith PN, Emery CL, Summers PE, Keevil SF et al.. Feasibility study of magnetic resonance imaging-guided intranasal flexible microendoscopy. Computer aided surgery : official journal of the International Society for Computer Aided Surgery 1997. link1097-0150(1997)2:5<264::AID-IGS2>3.0.CO;2-Y) 9 Cumberworth VL, Russell J, Colquhoun I, Mackay IS. Pneumatization of the uncinate process. The Journal of laryngology and otology 1993. link 10 MacLeod B. Paranasal sinus radiography. Emergency medicine clinics of North America 1991. link 11 Ruggles AJ, Ross MW, Freeman DE. Endoscopic examination of normal paranasal sinuses in horses. Veterinary surgery : VS 1991. link 12 Stammberger H. History of rhinology: anatomy of the paranasal sinuses. Rhinology 1989. link 13 Spector SL, Lotan A, English G, Philpot I. Comparison between transillumination and the roentgenogram in diagnosing paranasal sinus disease. The Journal of allergy and clinical immunology 1981. link90040-3)

Chronic aspergillosis of paranasal sinus