진균성 부비동염의 임상적 고찰

Background and Objectives: In recent years there has been an increase in mycotic infections of the nose and paranasal sinuses with frequent use of antibiotics, cytotoxic drugs, immuosuppressive therapy and increased survival of chronically debilitated patients. Diagnosis of mycotic sinusitis has advanced markedly with availability of computed tomography, magnetic resonance imaging and sinus endoscopy. The pathophysiology and clinical features of mycotic sinusitis are different according to invasive and non-invasive forms. This study were performed to evaluate 22 cases of mycotic sinusitis with their clinical presentation, course, diagnostic and treatment methods. Materials and Methods: Twenty-two cases of mycotic infections of the paranasal sinuses, which were confirmed histopathologiclly, from June 1996 through December 1999 were evaluated retrospectively depending on histopathology, clinical courses, diagnostic findings, and treatment results. Results: Of 22 cases 13 cases were non-invasive mycetoma and 11 cases were managed with endoscopic sinus surgery and 2 cases with Caldwell-Luc’s operation. Recurrences were not observed. Three cases with fulminant mycotic sinusitis were treated necrotomy and systemic amphotericin B injection. Three cases thought to be allergic fungal sinusitis showed positive allergic mucin and hyphae even though negative IgE-mediated atopy. Conclusion: Mycotic sinusitis should always be considered in the differential diagnosis of chronic or recurring sinusitis resistant to adequate medical treatment. Although definite diagnosis of mycotic sinusitis is based on histopathologic examination of removed materials from sinus, CT and MRI are highly sensitive diagnostic tools for evaluating this disease with diagnostic criteria. (J Clinical Otolaryngol 2000;11:286-292)