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Comprehensive management of paranasal sinus fungus balls: A Young-IFOS consensus statement

Abstract: Background: Paranasal sinus fungus balls (PSFB) are a common form of surgically treatable, noninvasive mycosis. To date, no guidelines have standardized PSFB treatment or management of difficult cases (eg, immunocompromised or fragile patients). The clinical consensus statement presented herein aims to provide a comprehensive management guide to PSFB based on current evidence. Methods: A multidisciplinary, international panel of 19 specialists judged statements in 3 rounds of a modified Delphi method survey. Statements encompassed the following PSFB management issues: definition, diagnostic workup; treatment indications and modalities; and follow-up. Otolaryngologists, maxillofacial surgeons, infectious disease specialists, and transplant physicians were considered the target audience. Results: Among the 23 statements, 7 reached strong consensus and 16 reached consensus. Consensus was reached on the definition, diagnosis, and treatment modalities for PSFB. Postoperative follow-up modalities and scenarios with bacterial superinfection were the most debated issues. Conclusion: Until further data are available, these points provide a framework for the management of PSFB. Moreover, PSFB should be considered a noninvasive mycosis that is not necessarily symptomatic or related to odontogenic conditions. Although diagnosis may be incidental, endoscopy and single imaging (computed tomography or magnetic resonance imaging, with distinctive features) are required for diagnosis, whereas contrast medium would allow for differential diagnosis. Although treatment of PSFB should be considered mandatory before sinus augmentation and is recommended for symptomatic patients, immunosuppressed patients, or patients with planned immunosuppression, watchful waiting could be considered for asymptomatic patients with chronic rhinosinusitis who are provided with appropriate advice and assessment.

 Fuente: International Forum of Allergy and Rhinology 2022;1-9

 Publisher: Wiley-Blackwell

 Year of publication: 2022

 No. of pages: 9

 Publication type: Artículo de Revista

 DOI: 10.1002/alr.23093

 ISSN: 2042-6976,2042-6984

 Publication Url: https://doi.org/10.1002/alr.23093

Authorship

SAIBENE, ALBERTO MARÍA

ALLEVI, FABIANA

CALVO-HENRÍQUEZ, CHRISTIAN

DAUBY, NICOLAS

DONDOSSOLA, DANIELE

HERVOCHON, RÉMI

LECHIEN, JÉROME R.

DAVID LOBO DURO

LOCATELLO, LUCA GIOVANNI

MANIACI, ANTONINO

MANNELLLI, GIUDITTA

MAYO-YÁÑEZ, MIGUEL

MAZA-SOLANO, JUAN

TADULESCO, THOMAS

TAN, NEIL

TINCATI, CAMILLA

TUCCIARONE, MANUEL

VAIRA, LUIGI ANGELO

SOWERBY, LEIGH