Allergic fungal sinusitis: radiological and microbiological features of 59 cases.

BACKGROUND AND OBJECTIVES: Allergic fungal sinusitis (AFS) is a relatively newly recognized entity consisting of a pansinusitis with allergic mucinous infiltrates in all involved sinuses. Historically mistaken for a paranasal sinus tumor, AFS is believed to be an allergic reaction to aerolized environmental fungi, usually of dematiaceous and Aspergillus species, in an immunocompetent host. We determined the occurrence of AFS in patients with chronic rhinosinusitis (CRS) to identify accurate preoperative parameters for AFS, as well as to identify the common fungi causing AFS in Saudi Arabia. METHODS: We conducted a retrospective chart review of 406 cases of CRS undergoing functional endoscopic sinus surgery from 2001 to 2005. Data regarding patient demographics, presenting symptoms, ENT examination, laboratory and radiological features, histopathological features and fungal culture was collected and analyzed. RESULTS: Fungal cultures were positive in 69 (16.9%) cases of CRS. Based on radiological features, histopathologic findings and culture results, AFS was diagnosed in 59 (14.5%) cases. Nasal polyposis was present in 56 (94.9%) cases; multiple sinuses were affected in all cases. Aspergillus species was the commonest causative fungal pathogen, being isolated in 40 (67.8%) cases, whereas dematiaceous fungi were isolated in 19 (32.2%) cases. CONCLUSIONS: AFS has been an underdiagnosed clinical entity. Only increased awareness among physicians of fungal involvement will increase accuracy of diagnosis.

Mobile phone induced sensorineural hearing loss.

The increased use of mobile phones worldwide has focused interest on the biological effects and possible health outcomes of exposure to radiofrequency fields from mobile phones, and their base stations. Various reports suggest that mobile phone use can cause health problems like fatigue, headache, dizziness, tension, and sleep disturbances; however, only limited research data is available in medical literature regarding interaction between electromagnetic fields emitted by mobile phones and auditory function; and the possible impact on hearing. We report a case of sensorineural hearing loss due to Global System for Mobile Communications mobile phone use, in a 42-year-old male.

Allergic fungal sinusitis in children in Saudi Arabia.

OBJECTIVE: To report the allergic fungal sinusitis (AFS) in children in Saudi Arabia and to review the experience of King Abdul-Aziz University Hospital in diagnosis and management of AFS in children. METHODS: Hospital charts of 45 children reviewed retrospectively. Clinical presentation, radiological and operative findings, management and outcomes studied. Only 25 patients had =or> 4 diagnostic criteria, treated endoscopically between January 2000 and December 2005 and followed at least 2 years in KAUH, Riyadh, Kingdom of Saudi Arabia. RESULTS: Twenty-five patients had at least 4 criteria for AFS. All patients underwent functional endoscopic sinus surgery (FESS) with high recurrence rate, 44%. Twenty-eight percent needed revision surgery even with medical treatment post operatively. Moreover, no other complications were reported in this study. Aspergillus spp is the most common fungal type in our review. CONCLUSION: Allergic fungal sinusitis in children is underestimated and understudied associated with poor outcome and high recurrence rate because of difficulty in management. Therefore, the most effective approach of AFS management in children is to have a high index of suspicion, adequate preoperative evaluation, medical preparation preoperatively, meticulous surgery, medical management, postoperative including topical and systemic corticosteroids and close clinical follow-up with endoscopically guided debridement.

Facial nerve anomalies in association with congenital hearing loss.

OBJECTIVE: Facial nerve (FN) anomalies are exceedingly rare. The association between a hearing loss and an anomalous facial nerve has never been touched deeply in the literature. The aim of this study is to report facial nerve anomalies in patients presenting with congenital hearing loss (COHL) and/or facial nerve palsy. METHODS: A retrospective chart review over 10 years from two academic tertiary referral centers. Eight patients were diagnosed with facial nerve anomalies in association with congenital hearing loss. The age ranged from 7 months to 13 years. RESULTS: Five patients had conductive congenital hearing loss (CCHL). Two had congenital sensorineural hearing loss (CSNHL). The eighth patient had a mixed hearing loss (MHL). Surgical findings for patients with conductive congenital hearing loss included facial nerve passing inferior to oval window (OW) (two patients), facial nerve covering head of stapes (three patients), deformed stapes (two patient), deformed incus (two patient), and absent incus (one patient). Radiological findings for patients with congenital sensorineural hearing loss and mixed hearing loss include, single cavity anomaly (one patient), dilated vestibule and superior semicircular canal (one patient), and absent internal auditory canal (IAC) (two patients). For patients with conductive congenital hearing loss, the radiological findings consistency demonstrates a soft tissue opacification in the middle ear. CONCLUSIONS: Congenital hearing loss may be associated with facial nerve anomalies. Pediatric otolaryngologists should be cautious when exploring patients with conductive congenital hearing loss.

Ophthalmic manifestations of paranasal sinus disease: a clinical grading system.

BACKGROUND: Ophthalmic complications are common manifestations of paranasal sinus disease. We propose a clinical grading system to standardize the category, treatment, and outcome of these complications. METHODS: Forty-two patients with paranasal sinus disease-induced ophthalmic complications were included in the study. The patients were categorized according to their clinical presentation: Grade I, patients with anatomical disturbance; Grade II, patients with ophthalmic functional involvement; Grade III, patients with orbital infection; and Grade IV, patients with visual impairment. RESULTS: The age of the patients ranged from 8 to 65 years (mean = 30 years). Overall, 36% patients had ophthalmologic manifestations with anatomical disturbance (Grade I), 26% had functional disturbance (Grade II), 26% had orbital infections (Grade III), and 12% had visual loss (Grade IV). The cause of the ophthalmic manifestations was allergic fungal sinusitis in 50%, chronic rhinosinusitis in 36%, acute sinusitis in 10%, and mucocele in 4%. The most common ophthalmic manifestation was proptosis (36%), followed by orbital infection (26%), functional involvement (26%), and visual impairment (12%). The patients underwent functional endoscopic sinus surgery and medical treatment when indicated. The outcome in Grades I, II, and III was favorable; the outcome in Grade IV was not favorable. CONCLUSION: This simple clinical grading system provides a useful tool for assessing the overall status of ophthalmic complications of Acute and chronic paranasal sinus disease at the initial clinical assessment and for subsequent management of these complications.

Computer-aided endoscopic sinus surgery: a retrospective comparative study.

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS), markedly improved with the introduction of new preoperative imaging techniques, intraoperative visualization tools, and the use of surgical navigation systems. In this retrospective study we evaluated the usefulness of CT-guided endoscopic sinus surgery and studied its advantages over conventional endoscopic sinus surgery. METHODS: We retrospectively reviewed the records of 60 randomly chosen patients with chronic rhinosinusitis (CRS) and moderate-to-severe sinonasal polyposis, undergoing endoscopic sinus surgery with surgical navigation (n=30) and without navigation (n=30). Data on the operative note, time of surgery, complications, and recurrence rate were collected and analyzed. RESULTS: Of the 60 patients, 40 (66.7%) were diagnosed with CRS and 20 (33.3%) had allergic fungal sinusitis. Primary surgery was performed in 37 (61.7%) and revision surgery was performed in 23 (38.3%) cases. The computer-aided surgery (CAS) group included 28 (93.3%) patients with extensive disease and 12 (40%) with bone erosions, with intraorbital or extradural extension, while the non-CAS group included 24 (80%) patients with extensive disease and seven (23.3%) with bone erosions, with intraorbital or extradural extension. The average operative time was approximately 13 minutes greater in the navigation group, with significant improvement in the recurrence rate (n=11, 36.7% in the non-CAS group; n=5, 16.7% in the CAS group), and intraoperative complications were fewer in the CAS group (two exposures of orbital fat in the non-CAS group; no complications in the CAS group). CONCLUSION: Computer navigational systems appear to serve as a valuable adjunct in preoperative planning and safe intraoperative dissection.