Effect of Antifungal Therapy on the Postoperative Period in Non-Invasive Fungal Sinusitis: A Systematic Review and Meta-Analysis.

Abstract

Background: Surgery is the primary treatment method for non-invasive fungal sinusitis, but challenges include prolonged postoperative inflammation recovery and high recurrence rates. Existing evidence regarding the role of antifungal therapy in enhancing postoperative recovery and reducing recurrence rates in non-invasive fungal sinusitis remains inconclusive. This meta-analysis aimed to systematically evaluate the impact of antifungal therapy on postoperative outcomes in non-invasive fungal sinusitis.

Methods: An eight-database systematic search was performed through March 1, 2025. Primary outcomes included relapse rate and total effective rate, with secondary outcomes consisting of adverse reaction incidence and average epithelialisation time. Subgroup analysis based on antifungal administration routes was also performed.

Results: The antifungal therapy group had significantly lower relapse rates (Odds Ratio [OR] = 0.27, 95% Confidence Interval [CI]: 0.18-0.40, p < 0.00001) and higher total effective rates (OR = 5.41, 95% CI: 3.17-9.23, p < 0.00001) compared to controls. Subgroup analysis showed that topical antifungal therapy (OR = 0.20, 95% CI: 0.12-0.32, p < 0.00001) had a more significant difference in relapse rates than systemic antifungal therapy (OR = 0.54, 95% CI: 0.27-1.05, p = 0.07).

Conclusions: Antifungal therapy after surgery for non-invasive fungal sinusitis, particularly topical antifungal therapy, is beneficial. However, the evidence is limited by the low quality of available studies. Future studies with larger sample sizes, multicentre designs and double-blind randomised controlled trials (RCTs) are necessary to validate these conclusions.