Isolated sphenoid sinus fungus ball: a retrospective study conducted at a tertiary care referral center in Korea.

Fungus ball (FB) is the most common form of extramucosal fungal rhinosinusitis involving one or more paranasal sinuses. The sphenoid sinus is an uncommon site of this disease. Here, we present our 20-year experience of managing isolated sphenoid sinus FB (SSFB). We retrospectively reviewed a series of 47 cases of isolated SSFB encountered between 1996 and 2015 with reference to the chronological incidence, demographics, clinical features, radiological findings, treatment modalities, and outcome. Recently, the number of patients with isolated SSFB has increased markedly. The mean age of the patients in this study was 63.1 years (range 26-84 years), and there was significant female predominance. The most common symptom was headache (72.3%), which was localised in various regions. On the other hand, nasal symptoms presented at a relatively low rate. On computed tomography, the most common findings were total opacification, calcification, and sclerosis of the bony walls. There was no significant difference in the presence of SSFB between the ipsilateral and contralateral sides of the nasal septal deviation and concha bullosa. Magnetic resonance imaging demonstrated an isointensity on T1-weighted images and marked hypointensity on T2-weighted images. Treatment consisted of endonasal endoscopic sphenoidotomy with complete removal of the FB. The prognosis was good, with no recurrence after a mean follow-up of 13.2 months. Isolated SSFB is a rare disease, but its prevalence is increasing. Although the clinical presentation is usually vague and nonspecific, SSFB should be considered in patients with unexplained headache, especially in elderly women. Endoscopic sphenoidotomy is a reliable treatment with low morbidity and recurrence rates.

Visual Acuity Impairment from Inflammatory Isolated Sphenoid Sinus Disease.

BACKGROUND/AIM: To investigate the treatment outcomes and determinants of prognosis in patients experiencing visual acuity (VA) deterioration due to inflammatory isolated sphenoid sinus disease (ISSD) who underwent endonasal endoscopic surgery (EES). PATIENTS AND METHODS: Thirteen patients with 14 lesions treated with EES between March 2010 and April 2022 were included. Evaluation included improvements in VA using the logarithm of the minimum angle of resolution (LogMAR) scale, resolution rates of associated symptoms, and identification of factors predicting VA recovery. A literature review was conducted to assess the outcomes for ISSD-related VA impairments. RESULTS: The most common etiology is mycetoma (n=5), followed by an equal representation of mucocele and sphenoiditis (n=4). The mean interval from symptom onset to intervention was 4.7 months, with an average follow-up duration of 14.4 months. Seven eyes exhibited preoperative VA of 2.1 LogMAR or worse, with diplopia/ptosis (n=8) and headache (n=5) being the predominant co-occurring symptoms. After surgery, all ancillary symptoms improved, with an overall VA recovery rate of 87.5% (improvement more than 0.2 logMAR units). Mucocele exhibited the best improvements, whereas sphenoiditis showed the least progress (p=0.021). Poor baseline VA (p=0.026) and combined diplopia/ptosis (p=0.029) were identified as negative prognostic factors for VA recovery. CONCLUSION: Our findings suggest a favorable prognosis for VA recovery following EES in patients with inflammatory ISSDs, with response variations based on disease entity. However, further research is needed to personalize therapeutic strategies for enhanced outcomes.

[The giant fungal body in the sphenoidal sinus and the destruction of the skull base].

The objective of the present study was to estimate the efficacy of the optical systems with the variable visual field angle applied for the endoscopic interventions on the paranasal sinuses. The authors report a clinical observation of the patient presenting with the giant fungal body in the sphenoidal sinus responsible for the partial destruction of the bone canal of the optic nerve and the internal carotid artery. The patient was treated by endoscopic shenoidotomy through the paraseptal approach with the use of a sinuscope with the variable visual field angle. It was shown that the use of optical devices with the variable visual field angle makes it possible to significantly reduce the duration of the surgical intervention, facilitates orientation in the difficult-of-access regions , and ensures adequate control during the removal of neoplasms at the basis of the skull.

[Neurological manifestations of isolated sphenoiditis].

OBJECTIVE: To review the neurological manifestations of isolated sphenoiditis. METHODS: The symptoms, signs, imaging data, diagnoses and outcomes of 14 cases with sphenoiditis hospitalized in Peking Union Hospital June 1995-January 2001 were analyzed retrospectively. RESULTS: The chief complaints of this group included headache (12 cases), visual loss and/or diplopia (7 cases), blood in nasal discharge (3 cases), purulent nasal discharge (2 cases), exophthalmoptosis (1 case), fixation of eyeball (1 case), and pharyngodynia (1 case). Six patients presented deficits of the second and/or third, fourth, and sixth cranial nerves; one patient had hemiplegia and aphasia; no more presentation of nervous system was found in all patients. Only five patients showed signs of posterior sinusitis in rhinologic examination. CT and/or MRI revealed isolated sphenoiditis (11 cases) and sphenoiditis with posterior ethmoiditis (3 cases). The complications of this group were intracranial infection involving frontal, temporal, and parietal lobes and brainstem (1 case), aneurysm of cavernous carotid artery (1 case), nasal cerebrospinal fluid leakage (1 case), optic neuritis (5 eyes), abducent paralysis (2 cases), orbital cellulitis (1 case) and orbital apex syndrome (1 case). All of the patients underwent endoscopic sphenoid surgery. 13 patients were free of headache after surgery. One patient died because of hernia of brain. CONCLUSION: Headache can be the first or unique symptom of isolated sphenoiditis. Isolated sphenoiditis should be considered in diagnosis and differential diagnosis of headache. CT and MRI are the best tools in diagnosis of isolated sphenoiditis.

[Complicated isolated inflammatory sphenoiditis (apropos of 23 cases)]. / Sphénoïdites inflammatoires isolées compliquées (à propos de 23 cas).

Isolated inflammatory sphenoid sinusitis, associated with complications are rare. Authors report 23 cases in 8 years. The left sphenoid is the most often involved, in 50 years or more old females. Neurological complications are the most frequent (75% of the cases): isolated headache, neuro-ophtalmologic paralysis, meningitis, before respiratory complications (20%). A bacteriological etiology was found in 60% of the cases, and a fungal etiology in 25%. The treatment is based on a large endoscopic marsupialization of the sphenoid. Recovery is the rule, except for neuro-ophtalmologic paralysis which recovery is inconstant.

Acute isolated sphenoid sinusitis in children.

BACKGROUND: Isolated pediatric sphenoidal sinusitis is an uncommon disorder with sphenoiditis more commonly found as part of pansinusitis. Recognizing the condition on history and examination alone is difficult and delayed diagnosis many occur in many cases. Nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) are essential adjuncts to confirm diagnosis. This study was designed to confirm the clinical features and diagnostic difficulties associated with isolated sphenoidal sinusitis in children. METHODS: A 16-year review was performed of cases diagnosed and treated in a tertiary teaching hospital. RESULTS: Two different groups of patients were identified. One group presented with fever and headache, frequently associated with neurological complications. Swimming and/or diving could be identified as possible causative agents. The second group presented with headache alone and a less severe clinical presentation. CONCLUSION: Isolated pediatric sphenoidal sinusitis may be more prevalent than was previously thought with CT/MRI helping establish the diagnosis in many cases. Pediatricians should be aware of this unusual but still potentially devastating condition. A nasal endoscopy is a useful diagnostic tool in this patient group, being noninvasive and well tolerated in children and adolescents.

Surgical salvage for the non-functioning sinus.

The non-functioning or dysfunctional sinus is completely isolated from the remainder of the nasal cavity with no hope of normal ventilation despite the most aggressive medical therapy. Most often these sinuses are the result of mucosal stripping/removal during prior radical surgeries. The reason for these radical operations include treatment of neoplasm, but most often is for revision of inflammatory disease when prior procedures have not been successful at restoring ventilation and maintaining patent ostia. When faced with a dysfunctional sinus, rhinologists typically have two choices: repeat the radical obliterative procedure or attempt to restore function and ventilation by reestablishing a drainage pathway into the nasal cavity. This latter option seems to represent the best long-term chance for surgical success in these difficult cases, with repeat ablative procedures as a last resort.

Isolated oculomotor nerve palsy related to sinusitis?

The association of sinusitis with ocular motility disorders is a seductive theory due to their close anatomical vicinity. Typically, sinusitis can influence ocular motility by affecting single muscles or a combination of muscles and/or cranial nerves due to a local inflammatory tissue reaction. Although rare, sinusitis has been suggested at least as a cause for superior-branch oculomotor palsy. We report a case of progressive, isolated, third-cranial-nerve palsy caused by an aneurysm of the posterior-communicating artery that initially was thought to be related to pansinusitis.

Intracranial extension of sphenoid sinusitis.

BACKGROUND: The incidence of sphenoid sinusitis has decreased significantly since the pre-antibiotic era. Intracranial complications from isolated sphenoid sinusitis are rare but have a high morbidity and mortality. METHODS: A case of intracranial extension of sphenoid sinusitis in a 64-year-old woman is reported. RESULTS: A 64-year-old woman was initially seen unconscious with bacterial meningitis and cerebrospinal fluid (CSF) fistula. Imaging suggested sphenoid sinusitis with intracranial extension. She underwent a sinus drainage procedure, was placed on antibiotic therapy, and underwent a definitive sphenoid sinus obliteration. The patient made a satisfactory recovery. CONCLUSIONS: Despite the low incidence of intracranial complications of sphenoid sinusitis, the potential morbidity and mortality from such complications is high. We advocate aggressive management consisting of antibiotic therapy, sinus drainage, and definitive CSF fistula repair.

Amaurosis unilateral irreversible secundaria a esfenoetmoiditis / Unilateral irreversible visual loos due to sphenoethmoiditis

La celulitis orbitaria secundaria a sinusitits paranasal se caracteriza por proptosis, alteraciones en la movilidad ocular, edema palpebral, quemosisi y/o hiperemia conjuntival previos a disminución o pérdida de la función visual. En caso de sinusitis posterior o esfenoetmoidal, la pérdida temprana y rápidamente progresiva de la función visual puede anteceder o acompañar a signología orbitaria inflamatoria leve, pudiendo ser dicha pérdida resultado de la combinación de edema intracanalicular o alteraciones vasculares del nervio óptico. Se describe el caso de una paciente pediátrica con diagnóstico de esfenoetmoiditis y pérdida unilateral permanente de la función visual a pesar del tratamiento médico y quirúrgico