ABSTRACT
Abstract Introduction The sinus fungus ball is an agglomeration of debris and hyphae, mainly caused by Aspergillus fumigatus, within the paranasal sinus, commonly affecting a single sinus, and it only rarely affects the frontal sinus. Objective To identify the state of the art of fungus ball in paranasal sinuses, especially related to the epidemiology of the disease in the frontal sinus. Additionally, this article reports a rare case of fungus ball in the frontal sinus in an adult male, and discusses the variables of this condition related to the patient. Data Synthesis All of the 8 cases of fungus ball in the frontal sinus reported in this study affected male patients: 40% had unilateral disease, and 60%, bilateral disease, contrary to the incidence data of fungus ball in the other paranasal sinuses, which reports unilateral prevalence. However, in the present study, this index changes, with 50% of unilateral and 50% of bilateral incidence regarding frontal sinus involvement. The average age of the patients was 65.36 years (range: 60-74 years). The etiologic agent was Aspergillus spp., and the endonasal endoscopic therapeutic approach corresponded to 80% of cases, while frontal osteoplasty accounted for 20% of cases, reaffirming the prevalence data from other studies. Conclusion Despite being a low-incidence entity, frontal sinus fungus ball should be considered in patients with pain in the frontal region refractory to the usual clinical treatments.
ABSTRACT
Abstract Introduction: The relationship between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) is still a controversial issue in literature. Objective: A systematic review of the association between these two diseases in adult patients. Methods: Systematic review in PubMed and Cochrane Database with articles published between 1951 and 2015. We included all articles that specifically studied the relationship between CRS and GERD. Results: Of the 436 articles found, only 12 met the inclusion criteria. Eight cross-sectional articles suggest a relation between CRS and GERD, especially on CRS that is refractory to clinical or surgical treatment. However, the groups are small and methodologies are different. Four other longitudinal studies have assessed the effect of treatment with proton pump inhibitors (PPIs) on the improvement of symptoms of CRS, but the results were conflicting. Conclusions: There seems to be relative prevalence of reflux with intractable CRS. There is still a lack of controlled studies with a significant number of patients to confirm this hypothesis. Few studies specifically assess the impact of treatment of reflux on symptom improvement in patients with CRS.
Resumo Introdução: A relação entre a Doença do Refluxo Gastroesofágico (DRGE) e a Rinossinusite Crônica (RSC) ainda é tema de controvérsia em literatura. Objetivo: Revisão sistemática sobre a associação entre essas duas doenças em pacientes adultos. Método: Revisão sistemática no Pubmed e Cochrane Database com os artigos publicados entre 1951 e 2015. Foram incluídos todos os artigos que estudassem especificamente a relação entre RSC e DRGE. Resultados: Dos 436 artigos encontrados, apenas 12 satisfaziam os critérios de inclusão. Oito artigos transversais sugerem relação da RSC com a DRGE, especialmente sobre a RSC refratária a tratamento clínico ou cirúrgico prévio. No entanto, os grupos são pequenos e as metodologias são muito diferentes. Outros quatro estudos longitudinais avaliaram o efeito do tratamento com Inibidores de Bomba de Prótons (IBP) sobre a melhora a dos sintomas de RSC, porém os resultados foram discordantes. Conclusões: Parece haver relação de prevalência de refluxo e RSC de difícil controle. Ainda faltam estudos controlados com um número expressivo de pacientes para que se confirme essa hipótese. São escassos os estudos que avaliem especificamente o impacto do tratamento de refluxo na melhora dos sintomas em pacientes com RSC.