Systematic Review of Granulomatous Invasive Fungal Sinusitis Management

Abstract

Objectives

Granulomatous invasive fungal sinusitis (GIFS) affects immunocompetent individuals. There is ongoing debate over whether surgery, antifungal medication, or a combined approach is the best treatment. This article summarizes reports about GIFS and its management.

Methods

Eight search engines, gray literature, and review articles were searched. Two independent reviewer groups screened the eligibility of articles. An independent reviewer solved disagreements. Exclusion criteria included non-English language reports, papers with unavailable full-texts, reviews, publications before 1980, and studies lacking information about GIFS management.

Results

Of the 279 identified articles, 41 studies were included (n = 89 patients). Sinonasal GIFS with skull-base/intracranial extension was associated with an increase in mortality (p = 0.002, OR = 14.083; 95% CI = 1.753–113.157). Treatment was associated with an 87.2% remission rate (p < 0.001, OR = 7.818; 95% CI = 4.502–13.576); a combined medical and surgical approach had a 74.2% recovery rate. Of surgical interventions, the highest recovery rates were associated with endoscopic debulking (52.5%), extensive surgical debulking (32.5%), and open sinonasal approach (15%, p = 0.132). The utilization of voriconazole was associated with higher recovery rates, but this was not significant (76.9 vs. 56%, p = 0.548).

Conclusion

Sinonasal GIFS with skull-base/intracranial extension is associated with higher mortality rates. The superiority of the endoscopic debulking and voriconazole protocol in managing these cases warrants further investigation.

Level of Evidence

Level 4.