Management of allergic fungal sinusitis with postoperative oral and nasal steroids: A controlled study

March 31, 2009     Mubasher Ikram, FCPS, Akbar Abbas, FCPS, Anwar Suhail, FRCS, Maisam Abbas Onali, MBBS, Shabbir Akhtar, FCPS, and Moghira Iqbal, FCPS


In patients with allergic fungal sinusitis, the mainstay of treatment remains surgical removal of allergic mucin and fungal debris. But as a single modality, surgery is associated with high rates of recurrence, so a number of adjunctive medical modalities have been tried, including postoperative corticosteroid therapy. We conducted a study of 63 patients with allergic fungal sinusitis who underwent endoscopic sinus surgery with or without postoperative steroid therapy. A group of 30 patients who had been treated prior to January 2000 had undergone surgery only; their cases were reviewed retrospectively, and they served as historical controls. Another 33 patients who were treated after June 2000 underwent surgery plus oral and nasal steroid therapy. All patients were followed for a minimum of 2 years. Recurrences were seen in 50.0% (15/30) of the no-steroid group and 15.2% (5/33) of the steroid group-a statistically significant difference (p = 0.008). The results of our study strongly support the use of steroids to control allergic fungal sinusitis and prevent its recurrence, and we recommend further study to identify the optimal dosage and duration of therapy.

Bilateral transversely clefted middle turbinates

March 31, 2009     Laura M. Dooley, MD and C.W. David Chang, MD

Endoscopic view of purulent sphenoid sinusitis

February 1, 2009     Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS

Sinonasal mycetoma

October 31, 2008     Enrique Palacios, MD, FACR, Wesley Jones, MD, and Jorge Alvernia, MD

Complex odontoma of the nasal cavity: A case report

April 30, 2008     Michelle Soltan, MD and Ashutosh Kacker, MD


We describe the case of a 76-year-old man who presented with symptoms of chronic nasal obstruction and recurrent sinusitis of many years’ duration. The patient's history and radiographic findings established a diagnosis of a complex odontoma of the nasal cavity. The mass was surgically excised, and the diagnosis was confirmed by histopathology. The occurrence of an odontoma in the nasal cavity is extremely rare.

Neurosarcoidosis presenting as complicated sinusitis: A case report and review

February 1, 2008     Lt. Matthew T. Brigger, MD, Maj. Ian K. McLeod, MD, and Cdr. Martin P. Sorensen, MD


Sarcoidosis is a systemic granulomatous disease with widely variable clinical characteristics, including numerous head and neck manifestations. We describe the case of a 49-year-old man who presented to the emergency department with symptoms consistent with complicated sinusitis. He was ultimately found to have an atypical case of neurosarcoidosis. This case illustrates the varied multisystem presentation of sarcoidosis and the diagnostic considerations that are merited.

Endoscopic view of a septated concha bullosa

February 1, 2008     Eiji Yanagisawa, MD, FACS, Joseph P. Mirante, MD, FACS, and Dewey A. Christmas, MD

Marginal-zone B-cell lymphoma of the bony palate presenting as sinusitis

January 1, 2008     Lisa Skultety Ayers, DO, Jacqueline Oxenberg, DO, Seth Zwillenberg, MD, and Mahmoud Ghaderi, DO


The diagnosis of low-grade B-cell lymphoma consistent with marginal-zone lymphoma has proven to be challenging when the disease involves the hard palate. The diagnosis is complicated by the nonspecific nature of the presenting symptoms and a difficult-to-differentiate histologic picture. We describe a case of low-grade B-cell lymphoma of the hard palate with a delayed presentation. We also compare the features of this case with the features of the small number of other such cases that have been reported in the literature. Finally, we review the etiology of low-grade B-cell lymphoma, we discuss its radiologic and pathologic features, and we briefly describe the treatment options.

Successful treatment of invasive Aspergillus sinusitis with caspofungin and voriconazole

January 1, 2008     Lisa Chirch, MD, Patricia Roche, DO, and Jack Fuhrer, MD


Chronic invasive Aspergillus sinusitis is a rare and potentially devastating infection. Management typically requires extensive surgical debridement followed by long-term antifungal therapy, primarily with intravenous amphotericin B. We describe the case of an elderly woman who had been diagnosed with extensive Aspergillus sinusitis that had invaded critical structures. The extensiveness of the infection and the patient's frailty and unwillingness to undergo a disfiguring procedure precluded surgery, and her medical condition was too fragile to withstand amphotericin B therapy. Therefore, we decided to treat her with a combination of caspofungin and voriconazole, two relatively nontoxic antifungal agents that have different mechanisms of action. After administration of this novel regimen, the infection resolved rapidly.

Nodular fasciitis of the nasal cavity: A case report

December 1, 2007     David Mullin, MD, Fred W. Lindsay, DO, and Michael A. Keefe, MD


Nodular fasciitis is an uncommon tumor-like fibroblastic proliferation of the head and neck that is difficult to differentiate from its more malignant counterparts. Despite modern advances, making this distinction is challenging because the clinical presentation is nonspecific and the histologic and radiologic features are variable. Once nodular fasciitis is diagnosed, the primary treatment is conservative resection and observation. We describe a case of nodular fasciitis of the nasal cavity in a 43-year-old woman. To the best of our knowledge, this is only the second reported case of nodular fasciitis arising in the nasal cavity, and the first such case in an adult.

Endoscopic view of maxillary fungal sinusitis

July 31, 2007     Dewey A. Christmas Jr., MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Endoscopic view of allergic fungal sinusitis

February 1, 2007     Joseph P. Mirante, MD; Dewey A. Christmas, Jr., MD; Eiji Yanagisawa, MD
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