OBJECTIVE: The study was to evaluate the quality of life in patients with fungal rhino-sinusitis(FRS) and to investigate the relationship between different subjective tests.objective measures and that between subjective tests and objective measures. METHOD: Quantitative data of 18 preoperative recruits with FRS were collected by using sino-nasal outcome test-20 (SNOT-20) and then the SNOT-20 items were categorized into five domains, a visual analogue scale (VAS). Lund-Kennedy endoscopy staging system and the Lund-Mackay CT staging system. Correlation among these data was analyzed. RESULT: The six highest score items in SNOT-20 were Facial pain/pressure, Thick nasal discharge, Need to blow nose, Sneezing, Fatigue, and Frustrated/restless/irritable. The total SNOT-20 score was not correlated with the other objective or subjective tests(P > 0.05). However, there was significant correlation between SNOT-20 nasal symptom domain and Lund-Mackay T score( r = 0.605, P < 0.01), as well as between SNOT-20 sleep related symptom domain and VAS (r = 0.605, P = 0.008). Significant correlation was found between the Lund-Mackay CT staging and the VAS (r = 0.6150, P < 0.01), as well as between the Lund-Mackay CT staging and the Lund-Kennedy endoscopy staging (r = 0.5001 P < 0.05). There was no significant correlation between Lund Kennedy endoscopy staging and the patient-based questionnaires (P > 0.05). CONCLUSION The objective measures were correlated well with each other and CT staging had significant correlation with the SNOT-20 nasal symptom domain and VAS. There was also significant correlation between SNOT-20 sleep related symptom domain and VAS.
Female ; Humans ; Male ; Middle Aged ; Mycoses ; diagnosis ; Quality of Life ; Sinusitis ; diagnosis ; microbiology ; Surveys and Questionnaires

A 70 years old male patient complained a sense of swelling on right facial, mild pain, and the obstruction of right nasal, no complain of facial numbness and toothache. Physical examination showed the slight bulging on right facial with mild tenderness, purulent nasal secretions on the right middle nasal meatus, and no significant neoplasm. CT scan showed that soft density tissue in the right maxillary sinus,and the high density tissue in some period. Postoperative diagnosis: carcinoma of maxillary sinus with fungal sinusitis.
Aged ; Carcinoma ; complications ; diagnosis ; Humans ; Male ; Maxillary Sinus ; microbiology ; pathology ; Mycoses ; complications ; Nose Neoplasms ; complications ; diagnosis ; Sinusitis ; microbiology

Actinomyces ; growth & development ; Coinfection ; Humans ; Maxillary Sinus ; Maxillary Sinusitis ; diagnosis ; microbiology

A young female complained repeated nasal discharge for over three months with discomfort of right cheek, and oral antibiotics had less effect. She has a history of "root canal therapy" five years before. Physical examination found purulent secretion in the right middle nasal meatus, and light tenderness in the right side of the maxillary sinus area. The CT scan of paranasal sinus shown possible fungal infection of right maxillary sinus. Finally the nasal endoscopic surgery confirmed the fungus ball of right maxillary sinus with foreign body (the root canal filling material).
Endoscopy ; Female ; Foreign Bodies ; diagnosis ; Humans ; Maxillary Sinus ; microbiology ; Maxillary Sinusitis ; microbiology ; Mycoses ; diagnosis ; Respiratory Tract Infections ; microbiology ; Tomography, X-Ray Computed

OBJECTIVE: To analyze the clinical characteristics, diagnosis and treatment course and clinical effect of non-invasive fungal rhino-sinusitis, and to investigate the diagnostic and treating methods and factors affecting the clinical outcome. METHOD: A retrospective study was conducted on 111 patients who were diagnosed with noninvasive fungal rhino-sinusitis from 2005 to 2009 in our department. Clinical symptoms, endoscopic and CT examinations, surgical methods, surgical outcomes and the treatment of the recurrent cases were reviewed. RESULT: Eighty-six cases were reassured of the non-invasive fungal rhino-sinusitis by means of clinical symptoms, endoscopic and CT examinations. All the patients who underwent functional endoscopic sinus surgery showed satisfying clinical effect and no complications occurred. During the follow-up, recurrence was found in 12 cases 1 to 5 years postoperatively, and 7 were cured after medication and debridement under endoscope in outpatient department while the clinical outcome of the other 5 was unsatisfactory. CONCLUSION Non-invasive fungal rhino-sinusitis is distinctive in endoscopic and CT examination which is different from common chronic rhino-sinusitis, and endoscopic sinus surgery is an effective treatment for the disease. Radical debridement and successful drainage of the nasal sinus is the key factor affecting the effect of the treatment and clinical outcome.
Adolescent ; Adult ; Aged ; Female ; Fungi ; Humans ; Male ; Middle Aged ; Mycoses ; diagnosis ; Retrospective Studies ; Rhinitis ; classification ; diagnosis ; microbiology ; Sinusitis ; classification ; diagnosis ; microbiology ; Young Adult

OBJECTIVE: To investigate the clinical and pathological manifestation, prognosis of unilateral allergic fungal sinusitis (AFS), and to analyze the characters and treatment paradigm of unilateral AFS. METHOD: Clinical and pathological information of 10 cases of unilateral AFS were analyzed. Nasal endoscopy, skin prick test, and visual analogue score (VAS) of severity of illness were taken before surgery. Mucosa membrane and inspissated secretion obtained during endoscopic surgery were stained with hematoxylin-eosin and silver hexosamine. Regular clean of sinus and intranasal steroid spray were taken after surgery. RESULT: Endoscopy showed that 5 cases had pale mucous membranes in the ipsilateral nasal cavity. Skin prick test was positive in all patients. Nasal CT scan demonstrated unilateral lesion in all 10 patients. In the involved sinus, all 10 patients had brown or yellow brown viscous secretion, which demonstrated eosinophilic amorphous mass with accumulation of eosinophils, Charcot-Leyden crystallization and fungal hyphae under microscope. The number of eosinophils in lamina propria of sinus mucosa membrane was 72 +/- 11/hpf. After follow-up for 16 to 26 months(mean 22 months), 9 cases were cured and 1 improved. The pre-operative VAS was 8.5 +/- 1.2, and the post-operative VAS was 1.1 +/- 1.0 (P < 0.01). CONCLUSION The systemic and local allergic reaction may co-exist in unilateral AFS, in which local hypersensitivity may be the dominant reaction. Endoscopic sinus surgery and intranasal steroid spray are effective in the treatment of unilateral AFS.
Adult ; Female ; Humans ; Male ; Middle Aged ; Mycoses ; diagnosis ; therapy ; Rhinitis, Allergic ; Rhinitis, Allergic, Perennial ; diagnosis ; microbiology ; therapy ; Sinusitis ; diagnosis ; microbiology ; therapy

OBJECTIVE: To improve the diagnosis and treatment of the acute attack of sphenoid and ethmoid fungal ball sinusitis based on the analysis of clinical features. METHOD: Eighteen patients with sphenoid and ethmoid fungal ball sinusitis were reviewed, and the main symptoms included headache and fever during acute attack. Endoscopy, nasal CT and MRI can provide useful information for diagnosis. Endoscopic sinus surgery was performed on thirteen patients after drug therapy, while the other 5 patients chose conservative therapy. RESULT: The pathological examination confirmed the fungal lesions and the 13 patients had a good recovery. The result of CT and MRI scanning had a good accordance with the intra-operative findings. One patient receiving conservative treatment had acute attack again 2.5 months later, and antibiotics and topical nasal drugs improved the symptoms. CONCLUSION Clinical presentation and radiological imaging contribute to the differential diagnosis of the acute attack of sphenoid and ethmoid fungal ball sinusitis, then the targeted therapy can be taken.
Adult ; Aged ; Diagnosis, Differential ; Ethmoid Sinus ; Ethmoid Sinusitis ; diagnosis ; microbiology ; therapy ; Female ; Fungi ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mycoses ; diagnosis ; therapy ; Retrospective Studies ; Sphenoid Sinus ; Sphenoid Sinusitis ; diagnosis ; microbiology ; therapy ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo differentiate between Aspergillus species and Mucorales of fungal sinusitis by immunohistochemistry.

METHODSFormalin-fixed paraffin-embedded tissue blocks of 66 cases of fungal sinusitis were retrieved from the archival files of Department of Pathology of Beijing Tongren Hospital during the period from 2001 to 2006. The samples included 29 cases of fungal balls, 12 cases of allergic fungal sinusitis, 24 cases of chronic invasive fungal sinusitis and 1 case of acute invasive fungal sinusitis. The types of fungi were 44 Aspergillus species (31 cases of A. fumigatus, 7 cases of A. flavus and 6 cases of A. terreus) and 22 Mucorales (14 cases of Mucor species and 8 cases of Rhizopus species). Immunohistochemistry was performed with MUC2, MUC5AC and MUC5B antibodies. The results were compared with histochemical study for periodic acid-Schiff (PAS) and Grocott methenamine silver (GMS) stains.

RESULTSImmunohistochemical study for MUC5B showed that the positive rate of Aspergillus species was 90.9%, in contrast to 4.5% in Mucorales (P < 0.001). The expression of MUC2 and MUC5AC was completely negative, whereas PAS and GMS stains were positive in all cases.

CONCLUSIONMUC5B antibody appears to be a useful immunohistochemical marker for identifying fungal types in tissue sections, especially in distinguishing between Aspergillus species and Mucorales in fungal sinusitis.

Antibodies, Fungal ; immunology ; Antibody Specificity ; immunology ; Aspergillosis ; diagnosis ; immunology ; Aspergillus flavus ; immunology ; Aspergillus fumigatus ; immunology ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; methods ; Mucin-5B ; genetics ; immunology ; Mucor ; immunology ; Mycoses ; diagnosis ; immunology ; microbiology ; Sinusitis ; diagnosis ; microbiology

OBJECTIVE: To develop a multiplex PCR method used to fast diagnose pathogenic fungi of fungal rhinosinusitis. METHOD: Three pairs of primers (universal fungus-specific primers, aspergillus specific primers, mucor specific primers)were used to establish multiplex PCR system. Detected six important medical fungi species strains to examine the applicability of the system and explore the optimum conditions. Multiplex PCR system was also used to identify pathogenic fungi of fungal rhinosinusitis, and used to compare the sensitivity with fungal culture. RESULT: Three pairs of primers of the multiplex PCR system had high versatility and specificity, and could amplify the corresponding DNA fragments in the appropriate conditions. Sensitivity of the reaction system was 10 microg/L. Twenty clinical specimens of fungal sinusitis were tested by fungal culture and the multiplex PCR system, 7 (35%) cases were culture positive whereas 15 (75%) cases were positive by the multiplex PCR system, the difference was statistically significant between the two methods (P < 0.05). CONCLUSION The multiplex PCR system was proved to be a rapid, sensitive and specific technology, it could be used to detect and identify clinical pathogenic fungi of fungal rhinosinusitis.
DNA Primers ; Female ; Fungi ; Humans ; Male ; Middle Aged ; Mycoses ; diagnosis ; Polymerase Chain Reaction ; methods ; Sensitivity and Specificity ; Sinusitis ; diagnosis ; microbiology ; Species Specificity

OBJECTIVE: To explore the diagnosis and treatment of the fungal ball rhino-sinusitis. METHOD: The clinical data of 128 cases with the fungal ball rhino-sinusitis in our hospital between September 2005 and January 2012 were retrospectively analyzed. All patients were accepted nasal endoscopic surgery and followed up after surgery. The diagnosis were confirmed by postoperative pathological examination. RESULT: The sinus of all patients epithelialized after the surgery from fourth to ninth weeks, one case recurred eight months later. CONCLUSION Sinus CT scan and nasal endoscopy were very important to the diagnosis of the fungal ball rhino-sinusitis, and nasal endoscopic surgery is the most important treatment method to fungal ball rhino-sinusitis.
Adult ; Aged ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Mycoses ; diagnosis ; surgery ; Nasal Surgical Procedures ; Retrospective Studies ; Sinusitis ; diagnosis ; microbiology ; surgery ; Tomography, X-Ray Computed ; Young Adult