Effectiveness of Functional Endoscopic Sinus Surgery in Treating Different Forms of Chronic Fungal Rhinosinusitis: When Is Surgery Alone Not Enough?
Notice bibliographique
Résumé
Background and Objectives Fungal rhinosinusitis (FRS) is an infection of the paranasal sinuses caused by fungal pathogens and is classified into non-invasive forms – fungal ball (FB) and allergic fungal rhinosinusitis (AFRS) – and invasive forms, such as chronic invasive fungal sinusitis (CIFS), based on the degree of fungal hyphae invasion [1,2]. Functional endoscopic sinus surgery (FESS) is widely considered the primary treatment method for FRS. However, its effectiveness varies depending on the specific subtype. Clinical evidence suggests that optimal outcomes are achieved through a combination of surgical and pharmacological therapy, especially to reduce recurrence rates and ensure long-term disease control [3-11]. Material (patients) and research method used This study is based on a systematic review of 12 clinical studies published between 2016 and 2024. Studies were selected following PRISMA guidelines and included only clinical trials evaluating surgical or combined treatment approaches for FB, AFRS, and CIFS. Study quality was assessed using the Newcastle-Ottawa Scale [8-11]. Findings/results in sufficient details to support conclusions Fungal Ball (FB): FESS alone was effective as the sole treatment method. The recurrence rate was low – between 1.1% and 1.87% [3,12], and only 10.7% of patients required revision surgery [4]. Antifungal medications were not used due to the noninvasive nature of the condition. Allergic Fungal Rhinosinusitis (AFRS): All reviewed studies employed a combination of FESS and medical therapy. Surgery alone was insufficient, with recurrence rates ranging from 17.1% to 33.6% [5-7]. Corticosteroid therapy significantly reduced recurrence rates (p < 0.05) [24], and itraconazole was effective in 20% of patients [5]. Chronic Invasive Fungal Sinusitis (CIFS): Surgery alone proved inadequate. Effective treatment required combined therapy using FESS and systemic antifungals such as voriconazole or amphotericin B. One study reported a 100% survival rate after combined therapy [10], while another showed 52% survival in immunosuppressed patients with systemic complications [11]. Conclusions and recommendations FESS is highly effective for treating fungal ball, but surgery alone is insufficient for AFRS and particularly CIFS. In AFRS, surgical intervention must be combined with corticosteroids, whereas CIFS requires systemic antifungal treatment in addition to surgery – especially in immunocompromised patients. Treatment strategies should be tailored to the specific FRS subtype and the degree of tissue invasion.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».