Less Invasive Surgery Is Effective, Safe for Fungal Sinus Disease

NEW YORK -- A destructive, soil-borne disease called allergic fungal sinusitis (AFS) is on the rise -- at least according to the uptick in cases referred to specialist Steven Schaefer, MD, chairman of the Department of Otolaryngology at The New York Eye and Ear Infirmary.

The good news, according to a paper written by Schaefer in the May, 2004 issue of the Journal of Neurosurgery, is that this obscure, insidious disease, which eats away at skull bone that surrounds the nose, eye and brain, now can be effectively and safely removed by minimally invasive techniques that use an endoscope guided through the nasal cavity. Until now, the standard procedure has been a full-blown craniotomy, a more radical approach.

Schaefer, who has written several text books on endoscopic techniques for paranasal diseases, surgically treats more than a dozen AFS patients a year.

The symptoms for allergic fungal sinusitis are the same as for other less serious forms of sinusitis, a disease which affects 37 million patients each year in the U.S., according to the National Institute of Allergy and Infectious Diseases. Patients with AFS experience facial pain, post-nasal drip, a loss of smell and have trouble breathing. X-ray imagery can pinpoint if the underlying cause is a fungus. Antibiotics are ineffective against AFS and anti-fungal agents work on only some patients. Surgery is required for advanced cases.

Allergic fungal sinusitis mimics cancer it is so destructive. It consists of benign polyps that keep spreading from the sinus to the orbit surrounding the eye, to the cranial cavity. At times, it can be aggressive and deadly, said Schaefer.

Our research shows that these cysts can be removed in a one-day endoscopic procedure vs. a 10-day hospital stay for a craniotomy. That is a wonderful improvement for patients, not only because of a shorter hospital stay, but because it avoids the potential for facial disfigurement that can arise from open surgery.

The retrospective study involved 21 patients who were treated by a multidisciplinary team of neurosurgeons and otolaryngologists using minimally invasive techniques. The follow-up period was from two to 19 years, and there were no cases of disease recurrence.

The New York Eye and Ear Infirmary, the oldest specialty hospital in the Western Hemisphere, is the primary teaching hospital for the New York Medical College. It has approximately 142,000 outpatient visits annually and over 20,000 surgical procedures per year. It has one of the nations most extensive eye, ear, nose and throat clinics.

Source: New York Eye and Ear Infirmary