scholarly journals Bioabsorbable Steroid-Releasing Sinus Implants in the Frontal and Maxillary Sinuses: 2-Year Follow-Up

2015 ◽  
Vol 6 (2) ◽  
pp. ar.2015.6.0117 ◽  
Author(s):  
Keith E. Matheny
Keyword(s):  
Topical Therapy ◽  
Signs And Symptoms ◽  
Sinus Surgery ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Inflammatory Bowel ◽  
The Right ◽  
Ethmoid Sinuses ◽  
Maxillary Sinuses

Background Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively. Outcomes have not yet been studied when these implants are utilized in other paranasal sinuses after ESS. Objective To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS. Methods 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations. In July, 2012, during revision left frontal sinusotomy and right maxillary antrostomy (the fifth ESS), two bioabsorbable steroid-releasing implants were placed in the left frontal recess and the right maxillary sinus respectively and followed clinically, endoscopically, and radiographically for two years. Results Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis. Conclusions The steroid-releasing implants during the critical phase of wound-healing appear to have allowed the patient, now over two years postoperatively, to achieve a healthier state and to allow more successful management than the preceding 15–20 years.

Acute proptosis secondary to bilateral pansinus mucopyocele with orbital compartment syndrome: a rare presentation, its management and outcome

2021 ◽  
Vol 14 (7) ◽  
pp. e241972
Author(s):  
Khushboo Chauhan ◽  
Tanya Sharma ◽  
Bhavana Sharma ◽  
Samendra Karkhur
Keyword(s):  
Compartment Syndrome ◽  
Nasal Polyposis ◽  
Signs And Symptoms ◽  
Sinus Surgery ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Guided Exploration ◽  
Rapid Relief ◽  
Maxillary Sinuses

A 37-year-old Indian female presented with forward protrusion of left eye for one week, associated with progressive diminution of vision. The patient had undergone sinus surgery for nasal polyposis a year ago. On examination, there was severe proptosis and limitation of extraocular movements in all gazes. CT-scan revealed a heterogeneous expansile mass, arising from left fronto-ethmoidal sinus, infiltrating left orbit. MRI showed T2-hyperintense, peripherally enhancing areas in bilateral nasal cavity (right >left), bilateral ethmoidal sinuses and frontal, sphenoidal and maxillary sinuses. Otorhinolaryngology consultation was sought and in view of vision threatening proptosis — with likely orbital compartment syndrome — emergent endoscopic guided exploration and orbital decompression was undertaken. Rapid relief of signs and symptoms was achieved, with normal vision, extraocular movements and resolution of proptosis. Cytology and microbiology ruled out infectious or malignant aetiology and helped in resolving a diagnostic dilemma. Histopathology confirmed the diagnosis of mucopyocele and follow-up period was uneventful.

scholarly journals Optic neuropathy due to allergic fungal rhinosinusitis

2011 ◽  
Vol 02 (02) ◽  
pp. 180-182 ◽  
Author(s):  
Jiji Tresa Cyriac ◽  
Tambi Cherian ◽  
Wasna Ali Hadi ◽  
Joyce Jose
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Anterior Segment ◽  
Sinus Surgery ◽  
Automated Perimetry ◽  
Blurred Vision ◽  
Eye Color ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
The Right

ABSTRACTAn uncommon case of allergic fungal rhinosinusitis presented to the ophthalmology outpatient department of our hospital with complaints of blurred vision in the right eye of a few days duration and vague complaints of pain around the eyes. The visual acuity on examination was grossly reduced in the right eye and normal in the left eye. Color vision was normal. Anterior segment examination including pupils was normal. Dilated fundus examination was normal except for temporal pallor in the right optic disc. Automated perimetry and magnetic resonance imaging (MRI) scan of brain and orbit were done. The imaging report showed a bilateral pansinusitis with pressure on the right optic nerve. Perimetry showed a superior field defect on the right side. ENT consultation and computed tomography (CT) with contrast helped to diagnose this as a case of allergic fungal rhinosinusitis. The patient was started on systemic steroids under the care of the ENT surgeon. After a few days, pre-operative assessment showed a gross improvement of visual acuity. Endoscopic sinus surgery was done to remove the polyps and thick mucus material. Histopathologic examination confirmed allergic fungal mucin. Days after surgery, the visual acuity improved further and repeat perimetry showed gross improvement in the visual field. Good history taking and a detailed ophthalmic examination, keeping in mind the probable causes of loss of vision of few days duration with no findings other than a decreased visual acuity and a suspicious disc, were key to the early diagnosis and investigation in this case. This helped in early referral and management of the case before permanent damage and irreversible visual loss occurred. The optic nerve is a cranial nerve which, once damaged permanently, will not regenerate. The amount of sinus involvement was extensive on both sides and invariably the left optic nerve would have been involved in a few days, if intervention was delayed.

scholarly journals Blindness from Fungal Rhinosinusitis of the Paranasal Sinuses: A Case Report

2020 ◽  
Vol 35 (2) ◽  
pp. 41
Author(s):  
Daniel Rico De Jesus ◽  
Patrick Joseph Estolano
Keyword(s):  
Nasal Congestion ◽  
Fungal Growth ◽  
Pregnant Patient ◽  
Sinus Surgery ◽  
Fungal Rhinosinusitis ◽  
History Of ◽  
Left Maxillary Sinus ◽  
The Right ◽  
High Index Of Suspicion ◽  
Ethmoid Sinuses

ABSTRACT Objective: To present a unique case of blindness resulting from fungal rhinosinusitis involving multiple sinuses mimicking a malignant process in a pregnant patient. Methods:Design: Case ReportSetting: Tertiary Government Training HospitalPatient: One Result: A 36-year-old pregnant woman developed unilateral blindness during her 20th week of gestation with a history of  binocular diplopia, unilateral nasal obstruction and anosmia for 13 months during the pre-pregnancy period. Sphenoid sinus malignancy was suspected on imaging. The planned biopsy was intraoperatively shifted to endoscopic sinus surgery when clay-like materials were seen involving the left maxillary sinus and bilateral sphenoid and ethmoid sinuses. Histopathologic examination confirmed fungal growth. Postoperatively, nasal symptoms resolved but blindness of the left eye and blurring of vision of the right eye persisted. Conclusion: Fungal rhinosinusitis rarely occurs in multiple sinuses and is commonly misdiagnosed. It can afflict pregnant patients and mimic a malignant process. A high index of suspicion early on, especially in the presence of nasal congestion and diplopia may prevent potentially irreversible complications.

Subcutaneous Mepolizumab Injection: An Adjunctive Treatment for Recalcitrant Allergic Fungal Rhinosinusitis Patients With Asthma

2020 ◽  
pp. 194589242095148
Author(s):  
John Karp ◽  
India Dhillon ◽  
Rikesh Panchmatia ◽  
Amin Javer
Keyword(s):  
Sinus Surgery ◽  
Adjunctive Treatment ◽  
Eosinophilic Asthma ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Significant Difference ◽  
Patient Reported ◽  
Snot 22 ◽  
Eosinophil Counts

Background Allergic Fungal Rhinosinusitis (AFRS) is a non-invasive fungal disease that results from chronic allergic inflammation of the sinonasal mucosa. Failure to respond to mainstay medical therapies and sinus surgery leaves AFRS patients with limited alternatives and a decreased quality of life. Mepolizumab is a known IL-5 antagonist for patients with severe eosinophilic asthma. Objective To identify the efficacy of mepolizumab on improving Modified Lund-Kennedy (MLK) endoscopic scores in recalcitrant AFRS patients with asthma. Methods Retrospective chart review of 27 recalcitrant AFRS patients with asthma receiving a monthly mepolizumab injection between January 2017 and July 2019. Patients were evaluated endoscopically at baseline and at each follow-up visit every 6–8 weeks until their third visit. Secondary outcomes included SNOT-22 scores, serum eosinophil counts and the rate of prednisone rescues required in patients receiving mepolizumab compared to a retrospective control arm. Results Total median MLK scores improved significantly for all patients over three follow-up visits (6[4,7], 4[2,6], 5[2,6], 3.5[2.25,5]; p = 0.04). Amongst patients with a baseline polyposis score of 1 or more, combined MLK edema and polyposis sub-scores significantly improved (6[5.25,6], 3.5[2.25,5,75], 4[2.75,5.25], 4[3,4]; p = 0.02) versus patients with no polyposis (4[3,4], 3[1,4], 4[2,4], 3[0,4]; p = 0.90). Total SNOT-22 scores (56 vs 43; p = 0.04) and eosinophil counts (0.40 × 109/L vs 0.00 × 109/L; p < 0.01) decreased significantly when comparing baseline to last follow up. There was no significant difference in rate of prednisone rescues per 1000 person-days when comparing control to Mepolizumab population (1.19 vs 1.23; p = 1). Conclusion Mepolizumab injections administered once monthly as an adjunctive treatment for recalcitrant AFRS patients with asthma appear to significantly reduce endoscopic signs of inflammation, patient-reported symptomatology and serum eosinophil levels. Patients with evidence of more severe endoscopic inflammation appear to benefit the most. Adjunctive treatment with mepolizumab does not reduce the need for prednisone rescues.

scholarly journals Allergic fungal rhinosinusitis: an overview on pathogenesis, early diagnosis and management

2018 ◽  
Vol 4 (3) ◽  
pp. 694 ◽  
Author(s):  
Neeraj Suri ◽  
Bhavya B. M.
Keyword(s):  
Nasal Obstruction ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Histological Evaluation ◽  
Nasal Discharge ◽  
Fungal Sinusitis ◽  
Surgical Specimen ◽  
Specimen Handling ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis

<p class="abstract"><strong>Background: </strong>The objective of the study was<strong> </strong>to evaluate the criteria for diagnosing allergic fungal rhinosinusitis and to maintain permanent drainage and ventilation, while preserving the integrity of the mucosa.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 50 patients with allergic fungal sinusitis with or without polyposis all of whom were treated with endoscopic debridement. Mucous sample collection, nasal secretion culture, surgical specimen handling, and histological evaluation of surgical specimens are described. All patients treated with endoscopic sinus surgery, debridement, post-operative use of steroids and antifungal therapy.  </p><p class="abstract"><strong>Results:</strong> Fungal mucin was found in all 50 cases, histology and fungal cultures confirmed the diagnosis. Out of 50 patients, 29 were females and 21 were males, with a mean age of 32 years. The most common symptom was nasal discharge 41 (82%) cases, nasal obstruction in 38 (76%) cases, headache and facial pain in 32 (72%) cases, 7 (14%) patients had bronchial asthma. Symptoms of nasal obstruction and nasal discharge were improved in 46 (92%) cases. All preoperative versus postoperative changes in AFRS associated complaints reached statistical significance of p value &lt;0.001 except in patients with asthma.</p><p class="abstract"><strong>Conclusions:</strong> Comprehensive management with endoscopic sinus surgery, oral steroids and antifungals reduces the recurrence or need for revision surgery. Long term follow up is very important.</p>

scholarly journals Orbital Emphysema after a Protracted Episode of Sneezing in a Patient with no History of Trauma or Sinus Surgery

2010 ◽  
Vol 89 (11) ◽  
pp. E12-E13 ◽  
Author(s):  
Qasim A. Khader ◽  
Khader J. Abdul-Baqi
Keyword(s):  
Signs And Symptoms ◽  
Sinus Surgery ◽  
Blowout Fracture ◽  
Orbital Emphysema ◽  
The Face ◽  
History Of ◽  
Limiting Condition ◽  
The Right ◽  
Systemic Antibiotics ◽  
Periorbital Swelling

Orbital emphysema is a benign self-limiting condition. It can occur directly (as a result of trauma to the face) or indirectly (secondary to a blowout fracture). We report a case of orbital emphysema in a 38-year-old man who presented with ecchymosis of the right eye, pressure within the right orbit, and periorbital swelling following a protracted episode of vigorous sneezing. The diagnosis was confirmed by computed tomography. Systemic antibiotics were given, and the patient was cautioned to avoid blowing his nose. His signs and symptoms resolved within 1 week.

scholarly journals Monophasic Epithelial Synovial Sarcoma Accompanied by an Inverted Papilloma in the Sphenoid Sinus

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Xiaohua Jiang ◽  
Qi Huang ◽  
Jianguo Tang ◽  
Matthew R. Hoffman
Keyword(s):  
Synovial Sarcoma ◽  
Sphenoid Sinus ◽  
Inverted Papilloma ◽  
Sinus Surgery ◽  
Nasal Discharge ◽  
Olfactory Sensation ◽  
History Of ◽  
The Right ◽  
Sphenoid Sinuses

A 58-year-old man presented with a six-month history of intermittent blood-stained posterior nasal discharge. Five years ago, he had a three-week episode of fitful light headaches. Nasal ventilation, olfactory sensation, and facial sensation were normal; there were no ophthalmological complaints. Coronal computed tomography (CT) scans revealed soft masses in the bilateral sphenoid sinuses with bone absorption. The patient underwent bilateral functional endoscopic sinus surgery and resection of right nasal papillary masses. Papillary masses and mucosa in both sphenoid sinuses were also removed. The mass in the left sphenoid sinus was diagnosed as two separate entities, one being a primary monophasic epithelial synovial sarcoma and the other an inverted papilloma, while the mass in the right sphenoid sinus was an inverted papilloma. After surgery, the patient underwent radiotherapy and chemotherapy. At the 50-month follow-up visit, there were no signs of recurrence.

Allergic fungal rhinosinusitis with skull base and orbital erosion

2009 ◽  
Vol 124 (2) ◽  
pp. 161-165 ◽  
Author(s):  
M S Marfani ◽  
M A Jawaid ◽  
S M Shaikh ◽  
K Thaheem
Keyword(s):  
Skull Base ◽  
Sinus Surgery ◽  
Common Finding ◽  
Nasal Discharge ◽  
Topical Steroids ◽  
Fungal Sinusitis ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Postnasal Drip ◽  
Imaging Results

AbstractIntroduction:Allergic fungal rhinosinusitis is a benign, noninvasive sinus disease related to hypersensitivity to fungal infection having bony skull base and orbital erosion as common finding.Patients and method:This descriptive study was conducted at the department of otorhinolaryngology, Dow University of Health Sciences, Karachi, Pakistan, from April 2003 to March 2006. In forty-seven proven cases of allergic fungal sinusitis the following information was recorded: demographic data, signs and symptoms, laboratory investigation results, imaging results, pre- and post-operative medical treatment, surgery performed, follow up, and residual or recurrent disease. The Statistical Package for the Social Sciences version 10.0 software was used for data analysis.Results:Findings indicated that allergic fungal rhinosinusitis usually occurred in the second decade of life (51.06 per cent) in males (70.21 per cent), allergic rhinitis (100 per cent) and nasal polyposis (100 per cent). Nasal obstruction (100 per cent), nasal discharge (89.36 per cent), postnasal drip (89.36 per cent), and unilateral nasal and paranasal sinus involvement (59.57 per cent) were significant features. Aspergillus (59.57 per cent) was the most common aetiological agent. Combined orbital and skull base erosion was seen in 30.04 per cent of cases, with male preponderance 6.8:1. Endoscopic sinus surgery was performed in all cases, and recurrent or residual disease was observed in 19.14 per cent.Conclusion:Allergic fungal rhinosinusitis is a disease of young, immunocompetent individual. Skull base and orbital erosion are seen in one-third of cases. Bone erosion is 6.8 times more common in males than females. Orbital erosion is 1.5 times more common than skull base erosion. Endoscopic surgical debridement and drainage combined with topical steroids leads to resolution of disease in the majority of cases, without resorting to systemic antifungal agents, craniotomy or dural resection.

Distinguishing Molecular Features of Allergic Fungal Rhinosinusitis

2018 ◽  
Vol 159 (1) ◽  
pp. 185-193 ◽  
Author(s):  
Matthew A. Tyler ◽  
Caroline J. Padro Dietz ◽  
Chris B. Russell ◽  
Martin J. Citardi ◽  
Shervin Assassi ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Chronic Rhinosinusitis ◽  
Quantitative Polymerase Chain Reaction ◽  
Sinus Surgery ◽  
Type I ◽  
Chain Reaction ◽  
Molecular Features ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Polymerase Chain

Objective Allergic fungal rhinosinusitis (AFRS) is a clinical subtype of chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by eosinophilic mucin, evidence of fungal elements within the mucin, fungal-specific type I hypersensitivity, and characteristic computed tomography findings. It remains controversial whether AFRS represents a disease with a unique pathophysiology from chronic rhinosinusitis or is merely a severe form of CRSwNP. The goal of this study was to identify molecular features unique to AFRS. Study Design Cross-sectional case-control. Setting Single academic tertiary referral institution. Subjects and Methods Subjects included 86 patients undergoing endoscopic sinus surgery: CRSwNP (n = 34), AFRS (n = 37), and healthy controls (n = 15). Pathway and correlation analyses were performed with whole-genome microarray data for study patients undergoing surgery for recalcitrant chronic rhinosinusitis. Our findings were confirmed with quantitative polymerase chain reaction and immunohistochemical studies. Results AFRS was uniquely characterized by a pronounced association with adaptive T helper 2–associated immune gene expression. AFRS exhibited altered expression of proteins associated with secretory salivary peptides—namely, histatin, a peptide with known antifungal activity in the oral cavity. Furthermore, the expression of histatins correlated negatively with that of type 2 inflammatory mediators. We confirm the decreased expression of histatins in AFRS when compared with CRSwNP by quantitative polymerase chain reaction and localized its expression to a submucosal cell population. Conclusion There exist clear molecular profiles that distinguish AFRS from CRSwNP. This divergence translates into an altered ability to control fungal growth and may in part explain some of the phenotypical differences between CRSwNP and AFRS.

Cerebral contrast staining mimicking parenchymal haemorrhage in a stroke patient

2020 ◽  
Vol 13 (12) ◽  
pp. e236400
Author(s):  
Elvin Yuan Ting Lim ◽  
Saravana Kumar Swaminathan
Keyword(s):  
Ct Scan ◽  
Middle Cerebral Artery ◽  
Signs And Symptoms ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Iodinated Contrast ◽  
Acute Infarct ◽  
The Right ◽  
The Brain

A 75-year-old female patient presented with signs and symptoms of a right hemispheric syndrome. A CT scan of the brain with angiogram showed an acute infarct in the right middle cerebral artery (MCA) territory secondary to thromb-occlusion of the M1 segment of the right MCA. A follow-up CT scan 2 weeks later showed a large hyperdense region in the infarcted area. With the aid of a dual-energy CT scan, this was eventually shown to be due to contrast staining from an earlier administration of iodinated contrast on the same day, rather than frank haemorrhagic conversion of the recent right MCA infarct.

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