Comprehensive management of paranasal sinus fungus balls: A Young-IFOS consensus statement.
antibiotics
computed tomography
endoscopy
guideline
maxillary sinus
mycosis
Journal
International forum of allergy & rhinology
ISSN: 2042-6984
Titre abrégé: Int Forum Allergy Rhinol
Pays: United States
ID NLM: 101550261
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
revised:
06
09
2022
received:
21
06
2022
accepted:
18
09
2022
medline:
25
4
2023
pubmed:
24
9
2022
entrez:
23
9
2022
Statut:
ppublish
Résumé
Paranasal sinus fungus balls (PSFB) are a common form of surgically treatable, noninvasive mycosis. To date, no guidelines have standardized PSFB treatment or management of difficult cases (eg, immunocompromised or fragile patients). The clinical consensus statement presented herein aims to provide a comprehensive management guide to PSFB based on current evidence. A multidisciplinary, international panel of 19 specialists judged statements in 3 rounds of a modified Delphi method survey. Statements encompassed the following PSFB management issues: definition, diagnostic workup; treatment indications and modalities; and follow-up. Otolaryngologists, maxillofacial surgeons, infectious disease specialists, and transplant physicians were considered the target audience. Among the 23 statements, 7 reached strong consensus and 16 reached consensus. Consensus was reached on the definition, diagnosis, and treatment modalities for PSFB. Postoperative follow-up modalities and scenarios with bacterial superinfection were the most debated issues. Until further data are available, these points provide a framework for the management of PSFB. Moreover, PSFB should be considered a noninvasive mycosis that is not necessarily symptomatic or related to odontogenic conditions. Although diagnosis may be incidental, endoscopy and single imaging (computed tomography or magnetic resonance imaging, with distinctive features) are required for diagnosis, whereas contrast medium would allow for differential diagnosis. Although treatment of PSFB should be considered mandatory before sinus augmentation and is recommended for symptomatic patients, immunosuppressed patients, or patients with planned immunosuppression, watchful waiting could be considered for asymptomatic patients with chronic rhinosinusitis who are provided with appropriate advice and assessment.
Sections du résumé
BACKGROUND
Paranasal sinus fungus balls (PSFB) are a common form of surgically treatable, noninvasive mycosis. To date, no guidelines have standardized PSFB treatment or management of difficult cases (eg, immunocompromised or fragile patients). The clinical consensus statement presented herein aims to provide a comprehensive management guide to PSFB based on current evidence.
METHODS
A multidisciplinary, international panel of 19 specialists judged statements in 3 rounds of a modified Delphi method survey. Statements encompassed the following PSFB management issues: definition, diagnostic workup; treatment indications and modalities; and follow-up. Otolaryngologists, maxillofacial surgeons, infectious disease specialists, and transplant physicians were considered the target audience.
RESULTS
Among the 23 statements, 7 reached strong consensus and 16 reached consensus. Consensus was reached on the definition, diagnosis, and treatment modalities for PSFB. Postoperative follow-up modalities and scenarios with bacterial superinfection were the most debated issues.
CONCLUSION
Until further data are available, these points provide a framework for the management of PSFB. Moreover, PSFB should be considered a noninvasive mycosis that is not necessarily symptomatic or related to odontogenic conditions. Although diagnosis may be incidental, endoscopy and single imaging (computed tomography or magnetic resonance imaging, with distinctive features) are required for diagnosis, whereas contrast medium would allow for differential diagnosis. Although treatment of PSFB should be considered mandatory before sinus augmentation and is recommended for symptomatic patients, immunosuppressed patients, or patients with planned immunosuppression, watchful waiting could be considered for asymptomatic patients with chronic rhinosinusitis who are provided with appropriate advice and assessment.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
877-885Informations de copyright
© 2022 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.
Références
Kim YK, Kim HJ, Kim HY, et al. Extrasinonasal infiltrative process associated with a sinonasal fungus ball: does it mean invasive fungal sinusitis. Diagn Interv Radiol. 2016;22(4):347-353.
Fadda GL, Allevi F, Rosso C, et al. Treatment of paranasal sinus fungus ball: a systematic review and meta-analysis. Ann Otol Rhinol Laryngol. 2021;130(11):1302-1310.
Kim JS, So SS, Kwon SH. The increasing incidence of paranasal sinus fungus ball: a retrospective cohort study in two hundred forty-five patients for fifteen years. Clin Otolaryngol. 2017;42(1):175-179.
Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(S29):1-464.
Rosenfeld RM, Nnacheta LC, Corrigan MD. Clinical consensus statement development manual. Otolaryngol Head Neck Surg. 2015;153:S1-S14.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol. 2021;74(9):790-799.
Liu X, Liu C, Wei H, et al. A retrospective analysis of 1,717 paranasal sinus fungus ball cases from 2008 to 2017. Laryngoscope. 2020;130(1):75-79.
deShazo RD, O'Brien M, Chapin K, Soto-Aguilar M, Gardner L, Swain R. A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 1997;123(11):1181-1188.
Craig JR, Poetker DM, Aksoy U, et al. Diagnosing odontogenic sinusitis: an international multidisciplinary consensus statement. Int Forum Allergy Rhinol. 2021;11(8):1235-1248.
Assiri AM, Ryu S, Kim JH. Concurrent diagnosis of sinus fungus ball and invasive fungal sinusitis: a retrospective case series. Mycoses. 2021;64(9):1117-1123.
Fadda GL, Succo G, Moretto P, et al. Endoscopic endonasal surgery for sinus fungus balls: clinical, radiological, histopathological, and microbiological analysis of 40 cases and review of the literature. Iran J Otorhinolaryngol. 2019;31(102):35-44.
Bulfamante AM, Pipolo C, D'Agostino FiorenzaU, et al. Spontaneous healing in maxillary fungus ball: beware of asymptomatic patients. Clin Case Rep. 2021;9(4):1865-1869.
Saibene AM, Vassena C, Pipolo C, et al. Odontogenic and rhinogenic chronic sinusitis: a modern microbiological comparison. Int Forum Allergy Rhinol. 2016;6(1):41-45.
Nicolai P, Lombardi D, Tomenzoli D, et al. Fungus ball of the paranasal sinuses: experience in 160 patients treated with endoscopic surgery. Laryngoscope. 2009;119(11):2275-2279.
Castelnuovo P, Gera R, Di Giulio G, et al. Paranasal sinus mycoses. Acta Otorhinolaryngol Ital. 2000;20(1):6-15.
Centre for Evidence-Based Medicine. OCEBM levels of evidence. Accessed: January 3, 2022. Available at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence
Lehmann AE, Raquib AR, Siddiqi SH, et al. Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: a randomized, double-blind, placebo-controlled noninferiority clinical trial. Int Forum Allergy Rhinol. 2021;11(7):1047-1055.