Burden of Fungal Rhinosinusitis in Rhinology unit of Tribhuvan University Teaching Hospital, Kathmandu

Abstract

Introduction: This longitudinal, prospective, descriptive study was carried out to find out  frequency and types of fungal rhinosinusitis, clinicopathologic features,its association with systemic disease and outcome of treatment.

Method: Patients who underwent endoscopic sinus surgery and fulfilled any of the  following two criteria were included in the study: unilateral sinonasal polyps, CT Scan showing soft tissue density with hyperdense areas, presence of fungal mucin or mud during surgery, histopathological report showing fungal infection. Surgical specimens were sent for KOH preparation, fungal culture and histopathological analysis.

Results: Out of 284 patients of chronic rhinosinusitis, 41(14.44%) patients had fungal rhinosinusitis, allergic fungal rhinosinusitis (40) and acute fulminantinvasive fungal rhinosinusitis (1). Age ranged from 14-63 years, 26 males and 15 females. Sixteen patients had unilateral disease. The common symptoms were nasal obstruction (41), decreased smell (24) and sneezing (21). Eight patients had hypertension, bronchial asthma (5), COPD(1), pulmonary tuberculosis (1), diabetes mellitus (2) of which 1 patient hadmucormycosis. All the patients had nasal polyps, 1 patient with mucormycosis also had mucopurulent,discharge from left middle meatus and diffuse swelling of left periorbital and maxillary area. Aspergillusfumigatus was isolated in 1 patient. Histopathological examination reported fungal polyp in 5 and mucormycosis in 1 patient. There is no recurrence till date.

Conclusion: Fungal rhinosinusitis is a common pathological entity. It affects both genders common in age group of 21-60 years. It presents as bilateral as well as unilateral nasal polyps. Nasal obstruction is the most common symptom followed by decreased smell and sneezing. Seventeen patients had systemic disease. The treatment protocol used was effective.