Management of invasive fungal rhino sinusitis in a tertiary health care center

Abhinav Thaduri, Samson Deva Kumar Kamanur, Dipin Kumar Vishnuvardan, A. V. S Hanumantha Rao, K. Sravani Reddy, Annam Chandrashekar


Background: Invasive fungal sinusitis, though considered to be rare entity, is nowadays frequently encountered, mostly in immunocompromised patients like uncontrolled diabetes, haematological malignancy and organ transplants on immunosuppressive drugs. There are only a few landmark studies from the Indian subcontinent on invasive fungal rhino sinusitis. The lack of awareness among clinicians regarding the varying clinical presentations of fungal rhino sinusitis prompted us to undertake this study, as our hospital is referral centre we get to see varying presentations and most terminal stages of disease.

Methods: This is a prospective study in which we report 30 cases reported to Gandhi Hospital, Secunderabad, invasive fungal rhino sinusitis. Evaluated in detail the clinical presentation, radiological features, specimens collected were subjected to both microbiology and pathologic examination; data collected and were analysed. Treated medically and surgically.  

Results: The most common co-morbid condition is uncontrolled diabetes mellitus. Mucoraceae (53%) and Aspergillus (10%) were the main fungi found. Mucosal biopsy confirmed fungal invasion to the nasal mucosa in all cases. Computed tomography and endoscopic findings showed a predominance of unilateral disease, with various stages of nasal involvement. All patients underwent surgical debridement and systemic antifungal therapy immediately after diagnosis.

Conclusions: Early medical and surgical treatment is essential to improve the prognosis along with better control of comorbidities.


Invasive fungal sinusitis, Amphotericin B, Debridement, Mucoraceae, CT para nasal sinuses

Full Text:



Beltrame A, Sarmati L, Cudillo L, Cerretti R, Picardi A, Anemona L, et al. A fatal case of invasive fungal sinusitis by Scopulariopsis acremonium in a bone marrow transplant recipient. Int J Infect Dis. 2009;13(6):488–92.

Lueg EA, Ballagh RH, Forte V. Analysis of the recent cluster of invasive fungal sinusitis at the Toronto Hospital for Sick Children. J Otolaryngol. 1996;25(6):366–70.

Blitzer A, Lawson W, Meyers BR, Biller HF. Patient survival factors in paranasal sinus mucormycosis. Laryngoscope. 1980;90(4):635–48.

Hayat M, Mushtaq S, Saba S, Saif R. Rhino-orbital-mucormycosis as a presenting manifestation of gestational diabetes mellitus. Indian J Endocrinol Metab. 2011;15(1):65-6.

Iwen PC, Rupp ME, Hinrichs SH. Invasive mold sinusitis: 17 cases in immunocompromised patients and review of the literature. Clin Infect Dis. 1997;24(6):1178–84.

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):1181–8.

Thanaviratananich PP and S. Impact of Treatment Time on the Survival of Patients Suffering From Invasive Fungal Rhinosinusitis. Clin Med Insights Ear, Nose Throat. 2014;(7):31–4.

Navya BN. Role of Histopathology in the Diagnosis of Paranasal Fungal Sinusitis. IOSR J Dent Med Sci. 2015;14(1):97–101.

Mehta R, Panda NK, Mohindra S, Chakrabarti A, Singh P. Comparison of Efficacy of Amphotericin B and Itraconazole in Chronic Invasive Fungal Sinusitis. Indian J Otolaryngol Head Neck Surg. 2013;65(2):288–94.

Schwartz LE. Acute Invasive Fungal Rhinosinusitis. Pathol Case Rev. 2011;16(6):230–3.

Suslu AE, Ogretmenoglu O, Suslu N, Yucel OT, Onerci TM. Acute invasive fungal rhinosinusitis: our experience with 19 patients. Eur Arch Otorhinolaryngol. 2009;266:77–82.

Ghazizade M, Asadi M, Yasseri AF, Karimi R, Med IJ, Health R. Invasive Fungal Rhinosinusitis : 41 cases. 2016;(9):78–81.

Kasapoglu F, Coskun H, Ozmen OA, Akalin H, Ener B. Acute invasive fungal rhinosinusitis: Evaluation of 26 patients treated with endonasal or open surgical procedures. Otolaryngol - Head Neck Surg. 2010;143(5):614–20.

Middlebrooks EH, Frost CJ, De Jesus RO, Massini TC, Schmalfuss IM, Mancuso AA. Acute invasive fungal rhinosinusitis: A comprehensive update of CT findings and design of an effective diagnostic imaging model. Am J Neuroradiol. 2015;36(8):1529–35.