Endoscopic Sinus Surgery For Non-invasive Fungal Sinusitis Of 24 Cases

Objective: Through clinical observation of 24 cases of non-invasive fungal sinusitis to analyze fungus ball and allergic fungal sinusitis between different clinical manifestations and summarize two different diagnosis、treatment and prognosis assessment.Methods: A retrospective, comparative analysis from July 2010 to December 2013 admitted to our hospital, diagnosed with chronic sinusitis and surgery has 123 patients, including 23 Department of pathologically confirmed fungus ball sinusitis(18.7 %), five according to Bent and Kuhn’s diagnostic criteria for the diagnosis of allergic fungal sinusitis(4.1%). For all patients underwent CT scan, endoscopy(Lund Kennedy score), postoperative pathological examination, Department of preoperative highly suspected allergic fungal sinusitis or postoperative patient department confirmed fungal secretion culture-positive serum Ig E test separately, sinus secretions send fungal culture in surgery patients. 2 weeks after surgery, one month after surgery, six months after surgery, an annual after surgery review of nasal endoscopy(Lund Kennedy score),1 year after surgery symptom assessment(visual analogue scale VAS), follow-up period of 1 year, 1 year fungus ball lost three cases, allergic fungal sinusitis a year lost one case.Results: The fungus ball and allergic fungal sinusitis belong in the classification of non-invasive fungal sinusitis, but both morphological, imaging, histopathology, treatment options and prognosis vary.Conclusion: Diagnosis of the two diseases is different. Functional endoscopic sinus surgery(FESS) has a radical effect on the fungus ball(P <0.05), allergic fungal sinusitis relapse rate, one case of recurrence after six months(25%). AFS surgery alone long-term effects is poor, and should promote a comprehensive treatment program. Oral prednisone and nasal steroid to reduce mucosal edema, have an important role in the prevention of early relapse. The clinical effects of antifungal agents are not sure, and more side effects, have a certain effect on recurrence. Immunotherapy can theoretically eliminate hypersensitivity,but in practice because of its expensive, long treatment period, access to a variety of purified fungal allergen difficulties and other reasons,is difficult to spread.