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Otol."],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0022215122000755_sec_a1\"><jats:title>Objective<\/jats:title><jats:p>To determine risk factors affecting mortality in acute invasive fungal sinusitis.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215122000755_sec_a2\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>This observational cohort study was conducted over a five-year period.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215122000755_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Of 109 recruited patients, 90 (82.6 per cent) had diabetes mellitus. Predominant fungi were zygomycetes (72.6 per cent) with <jats:italic>Rhizopus arrhizus<\/jats:italic> being most common. Of the patients, 12.8 per cent showed a positive biopsy report from radiologically normal sinuses. Factors affecting mortality on multivariate analysis were: female sex (<jats:italic>p<\/jats:italic> = 0.022), less than two weeks between symptoms and first intervention (<jats:italic>p<\/jats:italic> = 0.01), and intracranial involvement (<jats:italic>p<\/jats:italic> = 0.034). Other factors significant on univariate analysis were: peri-orbital swelling (<jats:italic>p<\/jats:italic> = 0.016), restricted ocular movements (<jats:italic>p<\/jats:italic> = 0.053), intracranial symptoms (<jats:italic>p<\/jats:italic> = 0.008), posterior disease (<jats:italic>p<\/jats:italic> = 0.058), imaging showing ocular involvement (<jats:italic>p<\/jats:italic> = 0.041), fungus being zygomycetes (<jats:italic>p<\/jats:italic> = 0.050) and post-operative cavity infection (<jats:italic>p<\/jats:italic> = 0.032). Bilateral, palatal and retromaxillary involvement were not associated with poor prognosis.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215122000755_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusion<\/jats:title><jats:p>Diagnosis of acute invasive fungal sinusitis requires a high index of clinical suspicion. Recognition of factors associated with poor prognosis can help when counselling patients, and can help initiate urgent intervention by debridement and antifungal therapy. Post-operative nasal and sinus cavity care is important to reduce mortality.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0022215122000755","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T06:26:10Z","timestamp":1647411970000},"page":"1320-1327","source":"Crossref","is-referenced-by-count":8,"title":["Risk factors and predictors of mortality in acute invasive fungal sinusitis \u2013 a single-institution experience"],"prefix":"10.1017","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9281-7071","authenticated-orcid":false,"given":"L","family":"Varghese","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Malleshappa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B K","family":"Yadav","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1857-6019","authenticated-orcid":false,"given":"R","family":"Kurien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Rupa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,3,16]]},"reference":[{"key":"S0022215122000755_ref1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1997.01900110031005"},{"key":"S0022215122000755_ref5","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.18.3.556-569.2005"},{"key":"S0022215122000755_ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-020-05879-y"},{"key":"S0022215122000755_ref7","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23912"},{"key":"S0022215122000755_ref21","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20014"},{"key":"S0022215122000755_ref27","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2003.016030"},{"key":"S0022215122000755_ref26","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2008.22.3141"},{"key":"S0022215122000755_ref14","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino14.183"},{"key":"S0022215122000755_ref8","doi-asserted-by":"publisher","DOI":"10.3201\/eid1509.090334"},{"key":"S0022215122000755_ref22","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215111001289"},{"key":"S0022215122000755_ref31","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-005-0919-0"},{"key":"S0022215122000755_ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-016-4109-z"},{"key":"S0022215122000755_ref12","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0000000000000048"},{"key":"S0022215122000755_ref16","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2015.29.4245"},{"key":"S0022215122000755_ref6","doi-asserted-by":"publisher","DOI":"10.1172\/JCI116419"},{"key":"S0022215122000755_ref13","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2015.29.4115"},{"key":"S0022215122000755_ref18","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815627786"},{"key":"S0022215122000755_ref19","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22172"},{"key":"S0022215122000755_ref9","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23978"},{"key":"S0022215122000755_ref15","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.129.2.236"},{"key":"S0022215122000755_ref24","doi-asserted-by":"publisher","DOI":"10.1177\/0003489418820871"},{"key":"S0022215122000755_ref28","doi-asserted-by":"publisher","DOI":"10.1097\/01.iop.0000225418.50441.ee"},{"key":"S0022215122000755_ref29","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21714"},{"key":"S0022215122000755_ref20","doi-asserted-by":"publisher","DOI":"10.4137\/CMENT.S18875"},{"key":"S0022215122000755_ref10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-250"},{"key":"S0022215122000755_ref25","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818765744"},{"key":"S0022215122000755_ref4","doi-asserted-by":"publisher","DOI":"10.1086\/432579"},{"key":"S0022215122000755_ref11","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0000000000001357"},{"key":"S0022215122000755_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2011.08.005"},{"key":"S0022215122000755_ref17","doi-asserted-by":"publisher","DOI":"10.1111\/myc.12884"},{"key":"S0022215122000755_ref30","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.160.1.3715034"}],"container-title":["The Journal of Laryngology &amp; 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