Acute invasive fungal rhinosinusitis: A 15-year experience with 29 patients

Marcus M. Monroe, Nathan Sautter, Timothy Smith, Peter Andersen, Mark Wax, Neil D. Gross

Research output: Contribution to journalArticle

Abstract

Objectives: 1. To document our 15 year experience with 29 cases of acute invasive fungal rhinosinusitis (AIFS). 2. To evaluate factors predictive of disease clearance and overall survival in this population Study Design: Case series with chart review Methods: 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 and treatment outcomes. Results: 29 patients with AIFS were identified. Causes of immunosuppression included hematologic malignancy (n=16), diabetes (n=10), medication (n=4) and AIDS (n=1). Facial pain and swelling and orbital symptoms were the most common presenting symptoms. Fungal organisms included mucorales (n=18) and aspergillus (n=10) species, with one patient infected with both. Disease-specific survival (DSS) from AIFS was 59%. Intracranial (p=0.01) and ethmoid sinus (p=0.05) involvement were significantly linked with short-term diseaserelated mortality. Overall survival (OS) at 6 months was 21%. For overall survival, intracranial involvement (HR 4.47, 95% 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 5 patients surviving >6 months, 2 developed long-term major sinonasal complications. Conclusion: DSS and OS remain low for patients with AIFS. 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 late sinonasal complications and should be followed closely.

Original languageEnglish (US)
JournalLaryngoscope
Volume121
Issue numberSUPPL. 5
DOIs
StatePublished - 2011

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Survival
Mucorales
Ethmoid Sinus
Cranial Nerve Diseases
Facial Pain
Hematologic Neoplasms
Aspergillus
Immunosuppression
Medical Records
Survivors
Acquired Immunodeficiency Syndrome
Demography
Mortality
Population
Therapeutics

ASJC Scopus subject areas

  • Otorhinolaryngology

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Acute invasive fungal rhinosinusitis : A 15-year experience with 29 patients. / Monroe, Marcus M.; Sautter, Nathan; Smith, Timothy; Andersen, Peter; Wax, Mark; Gross, Neil D.

In: Laryngoscope, Vol. 121, No. SUPPL. 5, 2011.

Research output: Contribution to journalArticle

Monroe, Marcus M. ; Sautter, Nathan ; Smith, Timothy ; Andersen, Peter ; Wax, Mark ; Gross, Neil D. / Acute invasive fungal rhinosinusitis : A 15-year experience with 29 patients. In: Laryngoscope. 2011 ; Vol. 121, No. SUPPL. 5.
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abstract = "Objectives: 1. To document our 15 year experience with 29 cases of acute invasive fungal rhinosinusitis (AIFS). 2. To evaluate factors predictive of disease clearance and overall survival in this population Study Design: Case series with chart review Methods: 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 and treatment outcomes. Results: 29 patients with AIFS were identified. Causes of immunosuppression included hematologic malignancy (n=16), diabetes (n=10), medication (n=4) and AIDS (n=1). Facial pain and swelling and orbital symptoms were the most common presenting symptoms. Fungal organisms included mucorales (n=18) and aspergillus (n=10) species, with one patient infected with both. Disease-specific survival (DSS) from AIFS was 59{\%}. Intracranial (p=0.01) and ethmoid sinus (p=0.05) involvement were significantly linked with short-term diseaserelated mortality. Overall survival (OS) at 6 months was 21{\%}. For overall survival, intracranial involvement (HR 4.47, 95{\%} 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 5 patients surviving >6 months, 2 developed long-term major sinonasal complications. Conclusion: DSS and OS remain low for patients with AIFS. 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 late sinonasal complications and should be followed closely.",
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