Aspergillus infection of paranasal sinuses

Aspergillus sinusitis is not an uncommon disease in our part of the world. There is still no consensus on classification of the disease and treatment methods have also not been standardized as yet. We assessed clinical characterization of the pattern of the disease in this clinical study. A total of 23 consecutive patients undergoing external ethmoidectomy for suspected fungal sinusitis were selected for the study. All patients included in the study were immunocompetent. Caseous material obtained following surgery was sent for microscopy with Potassium Hydroxide [KOH] and histopathological examination to know type of the fungus and nature of the disease. The average age of the patients was 27.7 years [SD 40 +/- 30]. They ranged in age from 10 to 70 years. There were 17 [73.91%] male and 6 [26.09%] female patients in this study. M: F ratio was 1:0.35. In 19 [82.61%] of 23 patients, Aspergillus species was found on microscopy and histopathological examination. Non-invasive disease revealed in 13 [56.52%] and invasive in 6 [26.09] patients. In 4 [17.39%] patients, simple inflammatory polyps were seen. For all practical purposes, Aspergillus infection of paranasal sinuses can be broadly divided into two categories, non-invasive Aspergillus sinusitis that usually presents as fungus balls or caseous material without fungal tissue invasion and invasive Aspergillus sinusitis with presence of septate hyphae in the soft tissue. The final specimen obtained during surgery should be submitted for histopathological examination to detect invasion of the tissues as this has effects on further treatment of disease