Effectiveness of Functional Endoscopic Sinus Surgery in Treating Different Forms of Chronic Fungal Rhinosinusitis: When Is Surgery Alone Not Enough?
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.030 | 0.080 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.006 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".