Endoscopic Sinius Surgery Combined with Middle and Inferior Meatus Fenestration for Fungal Ball Maxillary Sinusitis: A Randomized Controlled Trial_Chinese Journal of Evidence-Based Medicine

Authors：

SHI Qingyuan ¹ , DONG Shouhao ² , WU Liping ¹ , CHEN Xiaoyun ¹ , ZHANG Lu ¹ , ZHANG Chunhong ¹ , FANG Xiaobi ¹ , ZHUANG Jianhua ² , LIN Jiaxiang ² ,  LIAO Zhisu ¹

1. Department of ENT, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China;2. People’s Hospital of Lucheng District, Wenzhou 325000, China;

Corresponding author：

LIAO Zhisu, Email: liaozhisu111@163.com

Keywords：

Fungal ball maxillary sinusitis; Endoscopic sinus surgery; Inferior meatus fenestration; Randomized controlled trial; Efficacy assessment

DOI：

10.7507/1672-2531.20130144

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Objective 　To compare endoscopic sinius surgery plus middle meatus fenestration with endoscopic sinius surgery plus middle and inferior meatus fenestration for fungus ball maxillary sinusitis.
Methods 　Applying a prospective randomized controlled trial, 80 patients with fungal ball maxillary sinusitis from January, 2010 to March, 2011 were collected and then divided into two groups, including experiment (40 cases) and control groups (40 cases). The trial group received endoscopic sinius surgery plus middle and inferior meatus fenestration, which the control group received endoscopic sinius surgery plus middle meatus fenestration. Then a follow-up was conducted from the end of surgery to February 28th, 2013. All patients took subjective and objective assessment before and after the surgery, including VAS, SNOT-20, Lund-Mackay CT system scores and Lund-Kennedy endoscopic mucosal score.
Results 　with the trial group was superior to the control group in VAS score, SNOT rating and Lund-Kennedy mucosa score 6 months, 1 year, and 2 years after surgery (P lt;0.01). Lund-Mackay CT score of the control group was significantly higher than the trial group after 1 year of surgery (P lt;0.01). According to the Haikou standard to assess the efficacy of surgery, we found that the total effectiveness rate of the trial group (100.0%; recovery: 36 cases; improved: 4 cases) was higher than that of the control group (87.5%; recovery: 28 cases; improved: 4 cases), with a significant difference (P=0.021).
Conclusion 　Endoscopic sinius surgery plus middle and inferior meatus fenestration with a lower reoccurrence rate is superior to endoscopic sinius surgery plus middle meatus fenestration for fungus ball maxillary sinusitis in clinical efficacy.

Citation： SHI Qingyuan,DONG Shouhao,WU Liping,CHEN Xiaoyun,ZHANG Lu,ZHANG Chunhong,FANG Xiaobi,ZHUANG Jianhua,LIN Jiaxiang,LIAO Zhisu. Endoscopic Sinius Surgery Combined with Middle and Inferior Meatus Fenestration for Fungal Ball Maxillary Sinusitis: A Randomized Controlled Trial. Chinese Journal of Evidence-Based Medicine, 2013, 13(7): 801-806. doi: 10.7507/1672-2531.20130144 Copy

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2.	Dufour X, Kauffmann-Lacroix C, Ferrie JC, et al. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989-2002. Med Mycol, 2006, 44(1): 61-66.
3.	deShazo RD, O’Brien M, Chapin K, et al. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol, 1997, 9(4): 475-485.
4.	Ponikau JU, Sherris DA, Kern EB, et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc, 1999, 74(9): 877-884.
5.	Kaliner MA, Osguthorpe JD, Fireman P, et al. Sinusitis: bench to bedside. Current findings, future directions. J Allergy Clin Immunol, 1997, 99(6 Pt 3): S829-848.
6.	Nicolai P, Lombardi D, Tomenzoli D, et al. Fungus ball of the paranasal sinuses: experience in 160 patients treated withendoscopic surgery. Laryngoscope, 2009, 119(11): 2275-2279.
7.	Dufour X, Kauffmann-Lacroix C, Ferrie JC, et al. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989-2002. Med Mycol, 2006, 44(1): 61-67.
8.	Lai JC, Lee HS, Chen MK, et al. Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol, 2011, 268(2): 227-230.
9.	沈晓明. 耳鼻咽喉头颈外科学. 北京: 人民卫生出版社. 2008, 6.
10.	田元祥, 翁维良, 陆芳. 中医临床研究样本量设计的优化. 中华中医药杂志, 2010, 25(5): 710-715.
11.	Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol, 2004, 114(6 Suppl): 155-212.
12.	中华医学会耳鼻咽喉科学会, 中华耳鼻咽喉科学杂志编辑委员会. 慢性鼻窦炎鼻息肉临床分型分期内镜鼻窦手术疗效评定标准(1997年, 海口). 中华耳鼻咽喉科杂志, 1998, 33(4): 134.
13.	吴春霖, 王镭, 李卫兵. 临床试验随机化分组及其Stata的实现. 中国循证医学杂志, 2013, 13 (2): 242-244.
14.	Ferreiro JA, Carlson BA, Cody DT 3rd. Paranasal sinus fungus balls. Head Neck, 1997, 19(6): 481-486.
15.	Romett JL, Newman RK. Aspergillosis of the nose and paranasal sinuses. Laryngoscope, 1982, 92(7 Pt 1): 764-766.
16.	杨旭, 雷科. 真菌球型鼻-鼻窦炎49例分析. 中华耳鼻咽喉头颈外科杂志, 2006, 41(5): 380-381.
17.	Stevens MH. Primary fungal infections of the paranasal sinuses. Am J Otolaryngol, 1981, 2(4): 348-357.
18.	Tsai TL, Guo YC, Ho CY, et al. The role of ostiomeatal complex obstruction in maxillary fungus ball. Otolaryngol Head Neck Surg, 2006, 134(3): 494-498.
19.	Stammberger H, Jakse R, Beaufort F. Aspergillosis of the paranasal sinuses x-ray diagnosis, histopathology, and clinical aspects. Ann Otol Rhinol Laryngol, 1984, 93(3 Pt 1): 251-256.
20.	Lee KC. Clinical features of the paranasal sinus fungus ball. J Otolaryngol, 2007, 36(5): 270-273.
21.	Pagella F, Matti E, De Bernardi F, et al. Paranasal sinus fungus ball: diagnosis and management. Mycoses, 2007, 50(6): 451-456.
22.	Kirihene RK, Rees G, Wormald PJ. The influence of the size of the maxillary sinus ostium on the nasal and sinus nitric oxide levels. Am J Rhinol, 2002, 16(5): 261-264.
23.	Chobillon MA, Jankowski R. What are the advantages of the endoscopic canine fossa approach in treating maxillary sinus aspergillomas. Rhinology, 2004, 42(4): 230-235.
24.	李云川, 鲁辛辛, 张罗, 等. 真菌性鼻窦炎临床诊断和试验室诊断的对照研究. 中华医学杂志, 2009, 89(32): 2253-2256.
25.	王戬, 刘锋, 郑宏良. 慢性侵袭性真菌性鼻-鼻窦炎的诊治现状. 中国真菌学杂志, 2009, 4(2): 117-119, 128.
26.	黄少鹏, 李瑞玉, 叶青, 等. 鼻内镜手术治疗真菌球型鼻窦炎52例. 福建医科大学学报, 2007, 41(4): 377-378.

1. Thompson GR 3rd, Patterson TF. Fungal disease of the nose and paranasal sinuses. J Allergy Clin Immunol, 2012, 129(2): 321-326.
2. Dufour X, Kauffmann-Lacroix C, Ferrie JC, et al. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989-2002. Med Mycol, 2006, 44(1): 61-66.
3. deShazo RD, O’Brien M, Chapin K, et al. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol, 1997, 9(4): 475-485.
4. Ponikau JU, Sherris DA, Kern EB, et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc, 1999, 74(9): 877-884.
5. Kaliner MA, Osguthorpe JD, Fireman P, et al. Sinusitis: bench to bedside. Current findings, future directions. J Allergy Clin Immunol, 1997, 99(6 Pt 3): S829-848.
6. Nicolai P, Lombardi D, Tomenzoli D, et al. Fungus ball of the paranasal sinuses: experience in 160 patients treated withendoscopic surgery. Laryngoscope, 2009, 119(11): 2275-2279.
7. Dufour X, Kauffmann-Lacroix C, Ferrie JC, et al. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989-2002. Med Mycol, 2006, 44(1): 61-67.
8. Lai JC, Lee HS, Chen MK, et al. Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol, 2011, 268(2): 227-230.
9. 沈晓明. 耳鼻咽喉头颈外科学. 北京: 人民卫生出版社. 2008, 6.
10. 田元祥, 翁维良, 陆芳. 中医临床研究样本量设计的优化. 中华中医药杂志, 2010, 25(5): 710-715.
11. Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol, 2004, 114(6 Suppl): 155-212.
12. 中华医学会耳鼻咽喉科学会, 中华耳鼻咽喉科学杂志编辑委员会. 慢性鼻窦炎鼻息肉临床分型分期内镜鼻窦手术疗效评定标准(1997年, 海口). 中华耳鼻咽喉科杂志, 1998, 33(4): 134.
13. 吴春霖, 王镭, 李卫兵. 临床试验随机化分组及其Stata的实现. 中国循证医学杂志, 2013, 13 (2): 242-244.
14. Ferreiro JA, Carlson BA, Cody DT 3rd. Paranasal sinus fungus balls. Head Neck, 1997, 19(6): 481-486.
15. Romett JL, Newman RK. Aspergillosis of the nose and paranasal sinuses. Laryngoscope, 1982, 92(7 Pt 1): 764-766.
16. 杨旭, 雷科. 真菌球型鼻-鼻窦炎49例分析. 中华耳鼻咽喉头颈外科杂志, 2006, 41(5): 380-381.
17. Stevens MH. Primary fungal infections of the paranasal sinuses. Am J Otolaryngol, 1981, 2(4): 348-357.
18. Tsai TL, Guo YC, Ho CY, et al. The role of ostiomeatal complex obstruction in maxillary fungus ball. Otolaryngol Head Neck Surg, 2006, 134(3): 494-498.
19. Stammberger H, Jakse R, Beaufort F. Aspergillosis of the paranasal sinuses x-ray diagnosis, histopathology, and clinical aspects. Ann Otol Rhinol Laryngol, 1984, 93(3 Pt 1): 251-256.
20. Lee KC. Clinical features of the paranasal sinus fungus ball. J Otolaryngol, 2007, 36(5): 270-273.
21. Pagella F, Matti E, De Bernardi F, et al. Paranasal sinus fungus ball: diagnosis and management. Mycoses, 2007, 50(6): 451-456.
22. Kirihene RK, Rees G, Wormald PJ. The influence of the size of the maxillary sinus ostium on the nasal and sinus nitric oxide levels. Am J Rhinol, 2002, 16(5): 261-264.
23. Chobillon MA, Jankowski R. What are the advantages of the endoscopic canine fossa approach in treating maxillary sinus aspergillomas. Rhinology, 2004, 42(4): 230-235.
24. 李云川, 鲁辛辛, 张罗, 等. 真菌性鼻窦炎临床诊断和试验室诊断的对照研究. 中华医学杂志, 2009, 89(32): 2253-2256.
25. 王戬, 刘锋, 郑宏良. 慢性侵袭性真菌性鼻-鼻窦炎的诊治现状. 中国真菌学杂志, 2009, 4(2): 117-119, 128.
26. 黄少鹏, 李瑞玉, 叶青, 等. 鼻内镜手术治疗真菌球型鼻窦炎52例. 福建医科大学学报, 2007, 41(4): 377-378.

Chinese Journal of Evidence-Based Medicine

Endoscopic Sinius Surgery Combined with Middle and Inferior Meatus Fenestration for Fungal Ball Maxillary Sinusitis: A Randomized Controlled Trial

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