Materials and Methods
One hundred two patients of target group with clinical features of CAM
presenting to the outpatient Department of Otorhinolaryngology were
serially recruited and subjected to DNE by an experienced
Otorhinolaryngologist, and a tissue sample for KOH mount was sent from
representative areas. Informed consent was obtained from all individual
participants included in the study and ethical clearance was acquired
from the institutional ethical committee.
We excluded cases of invasive fungal sinusitis which were diagnosed
elsewhere or presented with recurrence or residual diseases. Nasal
endoscopy and biopsy for KOH mount were sent for all 102 patients but
CEMRI of paranasal sinuses, orbit & brain could be done in only 60
patients due to financial constraints. Nasal endoscopy was performed in
the operation theater using a zero degree rigid endoscope directly and
then after decongestion and local anesthesia. Bilateral evaluation was
done for all patients to compare both sides. The discoloration,
blackening, crusting, or necrotic areas over turbinates, septum, and
mucosa were considered as positive findings (Figure 1-e,f). Punch
biopsies from the affected tissues were taken. For those with normal
DNE, biopsy sample was taken from the middle turbinate of the side the
symptoms. The tissue samples were prepared and the KOH mounts were
examined for the presence of fungal elements by experienced
microbiologists. The morphological findings including broad aseptate
hyphae was considered as evidence of the presence of zygomycosis even
though invasive fungal sinusitis cannot be diagnosed solely based on the
presence of fungal elements on KOH mount. Non-enhancement, thin
enhancement, heterogenous enhancement, and enhancement with abnormal
findings on CEMRI were considered as positive findings (Figure 2).