RESUMEN
Although sinusitis affects about 20 % of the population, fungal sinusitis is rare. Aspergillus sp. are most frequently implicated. Fungal sinusitis represents a wide spectrum of disorders, including acute or chronic and invasive or non-invasive forms. Invasive fungal sinusitis may develop in an immunocompromised or diabetic patient, whereas non-invasive fungal sinusitis should be considered in a chronic situation, resistant to antibiotics in immunocompetent patients. Allergic fungal sinusitis is related to hypersensitivity of the host to the fungus. The diagnosis of these infections requires radiological examination and endoscopy with mucosal biopsies examined histologically and mycologically in order to distinguish the different types of sinusitis. In the non-invasive forms, surgical treatment is essential, sometimes combined with antifungal and anti-inflammatory treatment. The invasive forms require antifungal treatment, combined with surgery in some forms, particularly mucormycosis.
Asunto(s)
Micosis , Infecciones del Sistema Respiratorio/microbiología , Sinusitis/microbiología , Antifúngicos/uso terapéutico , Diagnóstico Diferencial , Humanos , Huésped Inmunocomprometido , Micosis/diagnóstico , Micosis/epidemiología , Micosis/terapia , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/terapia , Sinusitis/diagnóstico , Sinusitis/epidemiología , Sinusitis/terapiaRESUMEN
Evaluation of endoscopic ethmoidectomy performed as a day-case in terms of security, quality, and satisfaction of the patient. This prospective observatory bi-centric study over 1 year included 74 patients undergoing an ethmoidectomy respecting the eligibility criteria of ambulatory care. We recorded patients' demographic data, operative details, satisfaction, postoperative course, and follow-up results. Nasal symptoms were evaluated by SNOT-22 on preoperative appointment and postoperatively at D30. No non-absorbable nasal packing was used, eventually in the case of preoperative-bleeding absorbable gelatine packing. The postoperative follow-up took place at D1 by phone call and at D10 and D30 to assess complications, Visual Analogue Scale, and state of ethmoidal corridors by endoscopic exam. Patients benefited of bilateral ethmoidectomy in 82.4 % cases associated with septoplasty in 42 %. The majority (95 %) was discharged on the same day. Only one patient had bleeding at D0 and was kept in standard hospitalization, such as three other patients for medical or organizational reasons not related to surgery. At D1, 23 % described postoperative light bleeding but needed no revisit and pain was estimated at 1.3 (VAS). No readmission was observed, and no major complication was noted. SNOT-22 decreased successfully by 56 %, statistically related to postoperative treatment of corticosteroids and in the case of Samter triad. 97 % of patients were satisfied of the ambulatory care. These results suggest that within an experienced and dedicated day-case medical and paramedical team, ethmoidectomy can be safely performed on a day-case basis with high quality of taking care and satisfaction of patients.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Epistaxis , Senos Etmoidales/cirugía , Hemostasis Quirúrgica , Procedimientos Quírurgicos Nasales , Complicaciones Posoperatorias , Adulto , Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Epistaxis/diagnóstico , Epistaxis/etiología , Epistaxis/prevención & control , Femenino , Francia , Hemostasis Quirúrgica/métodos , Hemostasis Quirúrgica/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quírurgicos Nasales/efectos adversos , Procedimientos Quírurgicos Nasales/métodos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Prioridad del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Rinoplastia , Resultado del TratamientoRESUMEN
Aspergillus spp. invasive external otitis (IEO) is a rare infection. We performed a seven-year, single-centre retrospective study from 2007 to 2014 including all patients with proven Aspergillus spp. IEO. Twelve patients were identified. All patients had a poorly controlled diabetes mellitus and one underwent solid organ transplant. The most frequently isolated species was Aspergillus flavus (n = 10) and voriconazole was the first-line therapy in all cases, with a median length of treatment of 338.5 days (158-804 days). None of the patients underwent extensive surgery. The clinical outcome was excellent. However, otological sequelae were reported, including hearing impairment (n = 7) and facial palsy (n = 3).
Asunto(s)
Aspergilosis/diagnóstico , Aspergilosis/patología , Aspergillus/aislamiento & purificación , Necrosis/patología , Otitis Externa/diagnóstico , Otitis Externa/patología , Adulto , Anciano , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Aspergilosis/microbiología , Aspergillus/clasificación , Complicaciones de la Diabetes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Órganos/efectos adversos , Otitis Externa/tratamiento farmacológico , Otitis Externa/microbiología , Estudios Retrospectivos , Resultado del Tratamiento , Voriconazol/uso terapéuticoRESUMEN
Surgery and antifungals are the reference standard for rhino-orbito-cerebral mucormycosis (ROCM) treatment. The impact of local control on survival of 22 consecutive ROCM adults was studied on day 90: none vs. 75% died, respectively, with or without local control (p <0.0001). Hence, repeated surgical procedures are recommended to achieve local control of ROCM.