الفهرس 
Anatomy of NoseOnly 14 pages are availabe for public view
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Abstract
Invasive fungal rhinosinusitis is the most severe form of sinusitis affecting immunocompromised patients. Fungal spores wait for patient immune suppression and invade nasal mucosa, then extend to paranasal sinuses and notably can lead to serious morbidity and mortality.
It is highlighted now that the immunocompromising effects of corticosteroids with microangiopathy of diabetes and possible peripheral microthrombi in COVID-19 provide the ideal host for mucormycosis, which due to its inherent angioinvasive nature leads to the increased incidence.
So, in this study, we aimed at analysing the surge of invasive fungal rhinosinusitis reported during the Covid-19 pandemic to highlight aspects of disease and outcome of our approach with these cases in otorhinolaryngology department, Menoufia University.
In a prospective cohort study, we included 40 cases of acute invasive fungal rhinosinusitis who attended to Otorhinolaryngology department at Menoufia University hospitals between May 2021 and May2022. We assessed the patient clinically and radiologically. We collected data about sociodemographic features including sex, age, comorbidities, current or post COVID infection, received treatment, and history of steroid use. Patients were followed up after they received treatment, and survival analysis was conducted.
It is clear that all patients had a history of past COVID infection (100%) for which they received steroids. Concerning co-morbid conditions, over three fourths of the patients had diabetes, and around one third of them had hypertension. Additionally, history of CKD and malignancy was evident in 10% and 5%, respectively. Around three fourths of the study participants had uncontrolled HbA1C level while only 12.5% had normal or controlled level.
The most common presentation among patients was nasal obstruction, followed by orbital edema. Less commonly, 34% of patients had blindness and 32% had palatal affection, while headache affected only 20% of the patients. All patients had sino-nasal affection, while only 35 patients had sino-orbital affection. Fewer patients (29%) had sino-cerebral affection.
All patients received medical treatment; with the majority of them received amphotericin B. All patients underwent surgical treatment; with the majority of them Maxillectomy and endoscopic FESS. Fortunately, more than three fourths of them survived (87.5%).
Mucormycosis can be a fatal condition unless managed promptly. Comorbid conditions and associated complications are the main determinants of mortality. Early medical treatment accompanied by surgical treatment enhances the survival rate. Further studies on larger sample sizes are required to support our findings, in addition to involvement of longer duration of follow up period.