Background: We report the diagnosis, treatment and follow–up process of 22 cases of fungal SINUSITIS. Methods: This case- series study was carried out on 22 patients with fungal SINUSITIS that had treatment of endoscopy and antifungal drug. Past medical history, pathology, CT scan findings and treatment of patients were evaluated. Data analysis was done using SPSS. Findings: Twelve male (57%) and 10 female (43%) patients with the age of 16-73 years were a ssessed. Mucormycosis was seen in 18 (82%) and Aspergilosis in 4 (18%) patients. Diabetic mellitus (71%), chronic renal failure (CRF) (14.3%), and leukemia (9.6%) were reported as the most common underlying diseases. Maxillary and etmoid sinuses were the site of involvement. The most common sign was unilateral periorbital edema and proptosis (95%), and the most common symptom was unilateral change of visual acuity and cheek sensation (95%). All the patients had endoscopy surgery and treated with amphotricine B or ithraconazole and ceftrinaxone, metronidazole and vancomycine. Death was reported in 5 patients (22%) and renewed functional endoscopic sinus surgery (FESS) in 1 (4.8%). Conclusion: Functional endoscopic sinus surgery with amphotncine B or ithraconazole and follow-up are effective for fungal SINUSITIS.

Background and Objective: SINUSITIS is one of the most common hygienic problems and a large part of the budget has been allocated to its diagnosis and treatment yearly. In this study, the presence of cytomegalovirus in sinuses of patients, undergone operation for treatment, with or without SINUSITIS, was studied. Materials and Methods: This study was an applied and case-control study, which had bee performed on 44 HIV negative patients in ENT clinic of Shahid Mostafa Khomeini Hospital in Tehran during 4 months in 2005. Biopsy specimens were taken from left and right of uncinet process mucosa of middle meatus of 22 patients with chronic SINUSITIS and 22 patients without SINUSITIS undergo operation for nasal septal deviation. After purification of DNA, PCR test was done for replication of early gene in cytomegalovirus DNA by two kits, which was purchased from Cinnagen Co. and Gen Fanavaran Co. Results: After the electrophoresis of PCR product on agarose gel, neither of samples has shown DNA band same the positive control enclosed in kits. Therefore, all specimens were considered negative for cytomegalovirus DNA. Conclusion: Cytomegalovirus has not been detected in sinunasal mucosa of patients with chronic SINUSITIS and without SINUSITIS. Test with more specimens and other diagnostic procedure are recommended for prove of absence of cytomegalovirus in sinunasal mucosa.

Chest x-ray (Figure 3) demonstrated bilateral hilar lymphadenopathy and histopathological examination of the skin lesion, sinus and posterior auricular lymph node revealed non-necrotizing granulomatosis (Figure2). Laboratory examinations showed high ACE (Angiotensin Converting Enzyme) level, normal level of C-ANCA and negative PPD test. According to the constellation of findings on chest xray, histopathological examination of the skin, lymph node and sinus associated with elevated ACE level, and lack of response to multiple courses of antibiotic therapy and exclusion of other causes of granulomatous SINUSITIS, the diagnosis of “sarcoidosis” was confirmed.

Background & Aim: Invasive fungal SINUSITIS is an opportunistic infection by aspergilosis and mucoracae, but mucoracae is more common than aspergilosis. Mucormycosis is an acute opportunistic fungal infection mostly seen with an underlying disease. It has different clinical presentations such as rhinocerebral and orbital involvement, which are very aggressive and with high mortality rate. There is no obvious protocol for treatment of invasive fungal sinustis. Due to having lots of these patients it was decided to write a protocol for management and treatment. Patients & Methods: In this retrospective case series study, 21 patients who directly came or referred to this center were studied. As soon as taking a biopsy and after documentation and confirmation of pathology proper protocol was selected. Results: The most common site of involvement is nasal and orbit(52.4%) and then involvement of nasal cavity orbit and brain(38.1%) and involvement of nasal cavity alone(9.5%). There were 14 male(66.7%) & 7 female(33.3%). Out of these patients 19 had underlying disease including diabetes(10 cases), diabetes & renal failure(4 cases), ALL(2), end stage renal failure(1 case), SLE with ESRD(1 case) and CML in one case. Twelve patients were alive and 9 patients died. Those with nasal involvement alone were all alive. Of patients with sinonasal involvement only one patient died and those with sinonasal and brain involvement were dead. Conclusion: Treatment consists of early diagnosis, treatment of the underlying disease, debridement and medical therapy. Surgical protocol based on extension of disease consists of 3 groups: A: Surgical management in patients with sinonasal involvement is complete debridment of nasal and sinus. B: In patients with orbit involvement orbital exenteration is added. C: With involvement of brain, prognosis is poor and surgical and medical therapy can not affect the survival.