Analysis Of Clinical Specific Symptoms And Imaging Features Of Fungal Ball Sinusitis

Objective:To retrospectively analyze the clinical specific symptoms and imaging characteristics of fungal ball sinusitis,the characteristics of fungal spheroid ball sinusitis and fungal ball maxillary sinusitis were also contrastively analyzed so as to further deepen the understanding of this disease and improve the level of clinical diagnosis and treatment.Methods:This study collected the medical records and imaging data of 178 patients who were diagnosed as FBS in Guangyuan Central Hospital affiliated to North Sichuan Medical College from January 2015 to June 2020.The number of patients,age,gender,course of disease,clinical symptoms,past medical history and CT characteristics were summarized and analyzed.Statistical methods were used to compare and analyze FBSS and FBMS from different perspectives,including gender,age,course of disease,nasal septum deviation,CT features and clinical manifestations.Results:1.Clinical-specific symptoms of FBS:①Changes in the number of FBS patients:Admitted to our hospital,the number of FBS patients in 2019 is 1.91 times that of FBS in 2015 and has been increasing year by year in the past 6 years.②Age,gender,course of disease:the average age of 178 patients between 16 and 78 years old is 51.29±12.24 years old,among which the number of patients aged between 40 and 60 years old are the largest,accounting for 56.74%.In addition,FBS is more common in women with a male to female ratio of about 1:1.37.Generally,the course of disease ranges from 10 days to 20 years,however,the onset of the disease within a year is the most common,accounting for 56.74%.③Clinical manifestations:The most common symptoms are dizziness or headache,nasal congestion,runny nose,followed by nasal bleeding,but facial discomfort,decreased sense of smell,eye swelling,nasal odor and epiphora are rare;④Past medical history and underlying diseases:Among 178 FBS patients,hypertension and diabetes are more common,while previous tuberculosis,hyperthyroidism(hypothyroidism),anxiety and depression,and malignant tumors were less common.Moreover,there are 19 patients who underwent endoscopic nasal surgery in the past.2.The imaging features of FBS:①Most of the 178 patients with FBS are unilateral(169 cases),among which the maxillary sinus occupies first place(70.79%).Then,the incidence of sphenoid sinus comes second(16.85%).Maxillary sinus and ethmoid sinus are also common(8.99%).Besides,ethmoid sinus(2 cases)and frontal sinus(1 case)are rare;②The sinus cavity of 178 patients with FBS is full of soft tissue density shadow,of which soft tissue density image is uneven(87.08%)and uniform(12.92%).Meanwhile,soft tissues shows calcification(82.02%),hyperosteosclearosis(88.76%),and absorbed or destroyed bone(10.11%).There are a total of 144 cases of maxillary sinus involvement,among which the 83 cases are occluded,accounting for 57.64%;③Most of the 178 cases have nasal septum deviation(81.46%),and mild deviation is more common(46.90%);Among the 120 patients with unilateral maxillary sinus FBS,there are 98 cases of nasal septum deviation,47 cases of spacious side,and 51 cases of stenosis side.The difference is not statistically significant(P>0.05);④The accuracy of CT report is 60.11%.3.Comparative analysis of FBSS(group A)and FBMS(group B):①Both groups A and B are more common in women.In group A,women account for 66.7%,and in group B,women account for 58.7%.There is no statistically significant difference between the two groups(P>0.05);②The patients in group A and B are more than 40-60 years old,accounting for 73.3%and 64.3%,respectively.The difference between the two groups is not statistically significant(P>0.05).③The course of patients in groups A and B both are the most common within half a year,accounting for 36.7%and 28.6%,respectively.The difference between the two groups is not statistically significant(P>0.05);④CT characteristics:The proportion of calcifications in group A is significantly higher than that in group B,and the difference is statistically significant(P<0.05).The ratio of bone hyperplasia and bone resorption/destruction in group A is also higher than that in group B,but the difference is not statistically significant(P>0.05);⑤The ratio of deviated nasal septum in group A(86.7%)is higher than that in group B(77.8%),but the difference is not statistically significant(P>0.05);⑥The proportions of headache(96.7%),eye swelling(33.3%),and epiphora(26.7%)in group A are higher than that in group B,the difference is statistically significant(P<0.05).The facial discomfort(23.0%)of group B is higher than that of group A.The difference is statistically significant(P<0.05).The nasal symptoms of group B are nasal congestion(77.0%)runny nose(73.8%),tearing blood(27.0%),decreased sense of smell(17.5%),and nasal odor(12.5%),which are all higher than those in group A,but the difference is not statistically significant(P>0.05);⑦By logistic regression analysis,campared with group B,group A is characterized by lacrimatorrhea(OR=15.709))and eye distension(OR=3.531),all P<0.05.Conclusion:The number of FBS patients in our hospital increased year by year,and it is commonly seen in female patients aged 40～60.Most of the clinical manifestations are non-specific and CT is the most important preoperative auxiliary examination.FBS should be highly suspected in the presence of uneven soft tissue images with calcification and thickening of sinus wall on CT.FBSS and FBMS are the two most common types of FBS,but their clinical symptoms are different.Headache,lacrimatorrhea and eye distension are the specific manifestations of FBSS,while facial discomfort is the specific manifestation of FBMS.