The authors have no funding, financial relationships, or conflicts of interest to disclose.
Invasive Fungal Rhinosinusitis
A 15-Year Experience With 29 Patients
Article first published online: 16 FEB 2013
Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.
Volume 123, Issue 7, pages 1583–1587, July 2013
How to Cite
Monroe, M. M., McLean, M., Sautter, N., Wax, M. K., Andersen, P. E., Smith, T. L. and Gross, N. D. (2013), Invasive Fungal Rhinosinusitis. The Laryngoscope, 123: 1583–1587. doi: 10.1002/lary.23978
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 24 JUN 2013
- Article first published online: 16 FEB 2013
- Manuscript Accepted: 14 DEC 2012
- Manuscript Revised: 30 NOV 2012
- Manuscript Received: 21 FEB 2012
- invasive fungal sinusitis;
- rhinocerebral mucormycosis;
Document a 15-year experience with 29 cases of acute invasive fungal rhinosinusitis (AIFR) and evaluate factors predictive of disease clearance and overall survival.
Case series with chart review.
Patients were identified by review of department billing records between 1995 and 2010. Medical records were reviewed for patient demographics, disease characteristics, clinical course including surgical and medical therapy, treatment outcomes, and long-term survival.
Twenty-nine patients with AIFR were identified. Causes of immunosuppression included hematologic malignancy (n=16), diabetes (n=12), medication (n=10), and acquired immunodeficiency syndrome (n=1), with 10 patients having multiple causes of immunosuppression. Facial pain, swelling and orbital symptoms were the most common presenting symptoms. Fungal organisms included Mucor (n=18) and Aspergillus (n=10) species, with one patient infected with both. Disease-specific survival (DSS) from AIFR was 57%. Intracranial (P=.01) and ethmoid sinus (P=.05) involvement were significantly linked with short-term disease-related mortality. Overall survival (OS) at 6 months was 18%. For OS, intracranial involvement (hazard ratio [HR], 4.47; 95% confidence interval [CI], 1.51–13.22) and cranial neuropathy at presentation (HR, 3.2; 95% CI, 1.3–8.2) were significantly associated with shortened survival. Of the five patients surviving >6 months, two developed long-term major sinonasal complications.
DSS and OS remain low for patients with AIFR. Extensive surgical resection in patients with these poor prognostic signs should be considered carefully in light of their poor survival. Long-term survivors are at significant risk of sinonasal complications and should be followed closely.
Level of Evidence
4. Laryngoscope, 2012