A study of fungal diseases of nose and paranasal sinuses

Fungi are ubiquitous in nature and we are showered with their spores daily. Fungi infections of the nose and paranasal sinuses are not common in man in industralised countries. However in the recent past the fungal infections has been increasing both as ‘imported ills’ due to the greatly enhanced international traffic and as opportunistic infections in consequence of the use of powerful cytotoxic drugs (as applied to the treatment of neoplasms) and also steroid and antibiotic therapy. The most common site of fungal infections in man is the lung with or without haematogenous spread to other organs. But localised fungal infections can also occur in the upper respiratory tract and is more common than was previously suspected. Most fungal species which are pathogenic to humans, cause opportunistic infections and only dermatophytes are transmissible from host to host. The incidence of infections and deaths due to fungi has been grossly underestimated. Moreover the list of fungal species capable of producing diseases in immuno-compromised persons is increasing rapidly. Of the fungal infections of nose and para-nasal sinuses, Aspergillosis tops the list in terms of occurrence. Here, the ENT Department, Government Rajaji Hospital, Madurai with its advanced facilities serves as a referral centre provides various possibilities for carrying out a study in fungal infections focusing mainly on opportunistic infections of the nose and para-nasal sinuses. The lack of recognition of this disease and the scarcity of the reports prompted us to undertake the study. This study on fungal diseases of the nose and paranasal sinuses was conducted at ENT Department. Govt. Rajajji Hospital, Madurai on 50 cases. Out of these 50 cases all are Allergic Aspergillus sinusitis. The most common age group with fungal diseases of the nose and paranasal sinuses was between 21 – 40 years of age. There was a clear female preponderance with 64% and male cases constituted 36%. All patients in this study had nasal symptoms. The other most common symptom was headache seen in 76% of our cases. 50 patients (100%) presented with a nasal mass either polyps or fungal mass. The ocular sign were seen in 16% of cases. In our series of 50 cases, 50 (100%) histopathologically proven to be Allergic Aspergillus sinusitis. Fungal culture showed that Aspergillus flavus (40%), Aspergillus fumigatus (24%), Aspergillus niger (8%) and Aspergillus terreus (4%), were culture positive and no mucormycosis present. CT. scan was found to be highly valuable in pre-operative evaluation and intra-operative guidance