Fungus ball (FB) of the paranasal sinuses has a distinctive clinicopathological presentation. The disease occurs more frequently in elderly patients and has a female preponderance. Classically, it involves only one paranasal sinus in more than 90% of the cases, most commonly the maxillary sinus. Imaging characteristics (calcifications and / or erosion of the inner wall of the sinus visible on CT) and histopathological ones (luminal aggregation of fungal hyphae) confirm the diagnosis.
Allergic fungal rhinosinusitis (AFRS) usually occurs in younger, immunocompetent patients, with a history of atopy, including allergic rhinitis and / or asthma, or a long clinical picture of chronic rhinosinusitis (CRS), refractory to antibiotic treatment. Nasal polyps (NP) are present in almost all patients, while extra-sinusal complications are described only in some of them. Usually, there is involvement of several sinuses, as well as bilateral damage. The definitive diagnosis is confirmed only by examining surgical specimens - the characteristic appearance of eosinophilic mucin is the most reliable indicator of AFRS.
BACKGROUND. Chronic maxillary sinusitis is a frequently encountered pathology, resistant to treatment, which can cause significant economic losses. Considering these aspects, it is necessary to develop new methods of treatment.
OBJECTIVE. The purpose of this study was to assess the therapeutic efficacy of the “Cahul” ozonated mineral water in the treatment of experimentally induced chronic rhinosinusitis and its action on the mucosa of the maxillary sinus.
MATERIAL AND METHODS. The experimental study was conducted on a group of 14 chinchilla rabbits, aged between 8 and 12 months, weighing 2.5-3.0 kg, kept in vivarium conditions. In the first stage of the study, chronic rhinosinusitis was induced. 3 months after, maxillary antrostomy in the medial wall was performed on all animals included in the study; the intervention was performed under general anesthesia. The rabbits were divided into two groups. The rabbits enrolled in the study group underwent daily inhalations and maxillary sinus lavage with the “Cahul” ozonated mineral water. In the control group, inhalations and lavage were performed with 0.9% NaCl solution. Efficacy of the treatment was assessed observing the clinical character of the pathology. On days 2, 5 and 9 of the experiment, endoscopic and histological examinations were performed.
RESULTS. On the ninth day of treatment, if in the study group the appearance of the sinus mucosa was almost normal, in the control group, the histological examination revealed: epithelial hyperplasia, cylindrical cell hyperplasia, thickening of the basement membrane and lymphocyte infiltration. Mucosal fragments harvested after 5 days revealed submucosal fibrosis, leukocyte infiltration in the control group being more pronounced than in the study group.
CONCLUSION. Maxillary sinus lavage with the “Cahul” ozonated mineral water improves mucociliary clearance and stimulates regeneration of affected cells.
Invasive fungal rhinosinusitides are a group of disorders with three subtypes (acute invasive fungal rhinosinusitis, chronic invasive fungal rhinosinusitis and granulomatous invasive fungal rhinosinusitis), requiring urgent diagnosis and early treatment due to the reserved vital and functional prognosis. This disorder occurs in immunocompromised patients, but it can also occur in immunocompetent people. Aspergillus and Mucormicosis species are the most common microorganisms found in invasive fungal rhinosinusites. The otorhinolaryngologic clinical examination and imaging techniques provide important diagnostic information in patients with risk factors for invasive fungal rhinosinusitis, including intracranial or orbital extension identification. The treatment of invasive fungal rhinosinusites (acute or chronic) consists of reversing immunosuppression, appropriate systemic antifungal therapy and aggressive and prompt surgical debridement of the affected tissues.