Untreated sinusitis can lead to fungal infections, life-threatening complications

By Shalini Bhardwaj
New Delhi [India], August 9 : Untreated sinusitis can lead to fungal infections and life-threatening complications, as demonstrated by a recent case involving Dr RG, a 27-year-old physician.
Dr RG had experienced intermittent right-sided nasal obstruction for the past three months. He sought urgent medical attention when he suddenly lost vision in his right eye over three days.
A CT scan revealed that Dr RG was suffering from nasal polyposis and fungal sinusitis, which was compressing the optic nerve within the sphenoid sinus. This rare condition, if not promptly addressed, could lead to complete blindness in the affected eye.
He was administered IV antibiotics and steroids, which improved the signs of compression on the nerve. He underwent emergency sinus surgery with endoscopic optic nerve decompression.
During the surgery, the fungus was seen to be spreading in all sinuses and between the nerve and the brain layer in the sphenoid sinus. The disease was completely removed, and the nerve was decompressed and freed from the surrounding swollen nasal lining.
Dr Varun Rai, ENT Consultant at Sir Ganga Ram Hospital (SGRH), said, "These surgeries are extremely specialised because the optic nerve is very delicate and the slightest misstep can lead to permanent blindness. He used special instruments around the nerve so as not to cause pressure over the affected part of the nerve while still achieving complete clearance of fungal tissue around it. The nerve was then decompressed 270 degrees, leaving the blood supply to the nerve intact."
"In the immediate postoperative period, his vision improved and gradually returned to normal within 2 days. He was discharged in a stable condition in two days with a completely restored vision." He said
Dr Varun Rai added, "This case highlights the rarity of the condition and the fact that untreated sinusitis can lead to consequences that can have devastating complications."
He also mentioned that this case was unique in the sense that the anatomy of the sphenoid sinus was such that it allowed the fungus to creep in between the optic nerve and the brain dura layer, leading to compression and eventually blindness.
However, such cases are rare due to increased awareness, said, Dr Manish Munjal, ENT Senior Consultant, SGRH.
These cases are rare nowadays due to increased awareness and the availability of good diagnostic facilities. He also mentioned the increased incidence of such cases due to rising pollution levels, which lead to nasal allergic responses, Dr Munjal added.
The typical symptoms of patients are nasal stuffiness and discharge from the nose. The ENT doctor establishes a diagnosis based on an OPD-based endoscopic examination and a CT scan.