Efficacy of Different Modalities in Treatment of Different Types of Fungal Sinusitis

Abstract

Background: Fungal rhinosinusitis (FRS) includes a spectrum of disease processes that vary in clinical presentation, histologic appearances, and treatment options. Objective: This systematic review was done to reach the effective and safe method in management of FRS. Patients and Methods: Meta-analysis was performed in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This study used the published articles (from Jan1985 to Jan2018) in treatment of FRS via search in several databases. Results: Finally, forty-five studies were included in this study. Fifteen of them assessed the treatment of fungal ball (FB) using mainly the functional endoscopic sinus surgery (FESS) the success rate was 98.1%. Twenty included studies have evaluated the management of allergic fungal sinusitis (AFS) via FESS, Systemic steroids, Antifungals and immunotherapy. The results showed that FESS represents the first-line, followed by aggressive medical therapies, the recurrence rate after postoperative steroids was 20.6%, postoperative antifungals was 40% and after immunotherapy was 9.1%. Ten included studies considered the Invasive Fungal sinusitis. The results showed that the combination of systematic antifungal therapy and aggressive surgical debridement was the treatment of the choice. Conclusion: FESS is the treatment of choice for FB. AFS treatment consists of surgical extirpation of the allergic mucin and followed by anti-fungal therapy, Immunotherapy, and corticosteroids. Treatment of invasive fungal sinusitis includes surgical resection of necrotic tissues, systemic antifungal therapy and reversal of immune dysfunction.