[38] Invasive otitis externa caused by Aspergillus spp. may lead to skull base osteomyelitis with progressive cranial nerve palsies and can result in irreversible hearing loss and neurological impairment. Surgical debridement is indicated in invasive otitis externa to prevent

invasion into CNS in case of progression under systemic antifungal treatment. In a review by Parize et al. [39] from 2009, 25 cases of otitis externa were analysed, 18 patients received initial aggressive surgical debridement and six of them reached full recovery. Of the seven patients, who did not receive surgical intervention, five recovered. However, nothing is known about the initial extension of the otitis, some of the patients who reached full recovery without surgery might had only mild invasion

at an early stage. Patients at risk for invasive Decitabine clinical trial fungal sinusitis are frequently immunocompromised; however, the underlying disease varies from diabetes mellitus to bone marrow transplantation. The most commonly reported presenting symptoms are fever, headache, epistaxis, perinasal and periorbital pain and swelling, nasal congestion and rhinorrhea. check details Symptoms and signs such as nose ulceration, eschar of the nasal mucosa, black necrotic lesions and perforation of the hard palate are more specific; however, these findings are present only at an advanced stage, when the prognosis is already very poor and options for treatment very narrow. The diagnosis of Aspergillus sinusitis is mostly confirmed by histopathologic evaluation of biopsy 3-mercaptopyruvate sulfurtransferase specimens. However, culture can also lead to the diagnosis but is more time consuming. Additional investigations like rigid nasal endoscopy to evaluate the mucosa and to detect possible pieces of the fungus, and MRI and/or CT scan to evaluate the progression into the sinuses and

possibly the orbita and CNS, are also performed. In Aspergillus sinusitis, surgical debridement of infected sino-nasal tissue (with functional endoscopic sinus surgery or via an external approach) should be performed in case of progression under systemic antifungal therapy to prevent invasion into orbita, blood vessels, lung and CNS.[40] Gillespie published a discussion of 25 cases of invasive fungal sinusitis, 24 of which received surgical treatment (96%), varying from local debridement to total maxillectomy with orbital exoneration. Complete resection of the infected tissue seems to be of major importance for the outcome since nine of the 10 survivors had resection to viable bleeding tissue margins, whereas in all 9 patients who died from the infection infected tissue was left in place at the end of the surgical procedure.[41] In 2013, Gupta published a review discussing 16 cases of primary frontal sinus aspergillosis evaluating the outcome after endonasal endoscopic surgery. The frontal sinus is commonly affected in nasal and paranasal Aspergillus sinusitis; the infection, however, rarely occurs primarily in the frontal sinus.