LANDMARK: Survival in acute fungal sinusitis

Turner JH, Soudry E, Nayak JV, Hwang PH. Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. Laryngoscope. 2013;123(5):1112-1118

  • A systematic review comprising 52 studies of invasive fungal sinusitis. Analysis focused on presenting symptoms, prognostic factors for overall survival.
  • A total of 807 patients were included in that analysis. To perform valuable quantitative analysis data was extracted from studies and assembled into a single cohort.
  • Overall survival was 49.7% with most patients treated with both IV antifungals and surgery. The most common presenting symptom was facial swelling and fever. Nearly half of patients had diabetes of which nearly 50% presented with DKA. Half of all patients presented with disease in the orbit. 21% of patients presented with intracranial or hard palate involvement and 8% of patients had cavernous sinus involvement. Surgical therapy was divided evenly between open and endoscopic treatment.
  • Multivariate analysis revealed advanced age, and intracranial involvement as negative prognostic factors and diabetes and surgical resection as positive.
  • Acute invasive fungal sinusitis is a deadly disease process with high mortality and even with treatment high morbidity. Patients with intracranial involvement or those who did not receive surgery have a poor prognosis.
PMID: 23300010