الفهرس 
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Abstract
SUMMARY AND CONCLUSION
Chronic sinusitis is a common disease affecting all
age groups and causing symptoms varying from mild nasal
discharge to severe disability. (Mackay & Cole. 1987).
It is often of multifactorial aetiology including
mechanical obstruction (e.g. by F.B .• trauma or tumors),
infection. allergy. mucociliary clearance abnormality.
immune deficiency, autonomic imbalance, hormonal
disturbance and iatrogenic. (Mackay & Cole, 1987).
Infection is the most common cause of rhinosinusitis
because the nose and paranasal sinuses are in the ”front
line” of the respiratory tract, thus encountering
greater attacks from the environmental agents. It may be
viral. bacterial (both aerobic and anaerobic) or fungal.
(Mackay & Cole. 1987).
Mycotic infection of the nose and paranasal sinuses
is not uncommon and its incidence is increasing.
(Manning et al.• 1991). Beside being a cause of
increasing resistance to treatment. fungal infection of
the paranasal sinuses may have serious complications e.g.
multiple intracranial mucoceles. Optic neuropathy and
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orbitopathy. (Aviv et al., 1990, Salitan et al., 1990
and Maskin et al., 1989).
The aetiologic agents implicated in fungal sinusitis
include Aspergillus, Bipolaris, Exserohilum, Curvularia,
Alternaria, Basidiomycetes (Mushrooms), Myriodontium
keratinophilum and Paecilomyces lilacinus (Manning et
al., 1991; Aviv et al., 1990; Bartynski et al., 1990 and
Catalano et al., 1990).
Diagnosis of fungal sinusitis depends mainly on
careful communication with the mycology laboratory and
direct microscopic examination of tissue biopsy
specimens. However, endoscopy of the paranasal sinuses,
computerized tomography (C.T.) scan and magnetic
resonance (M.H.) imaging are of great help in the
diagnosis of fungal sinusitis. (Manning et al;, 1991;
Avivet al., 1990).
Our study was conducted on 27 patients suffering
from chronic sinusitis, 16 males and 11 females, ranging
in age between 12 and 55 years with a mean age of 22.3
years.
The 27 patients underwent puncture and lavage
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operation which was done in the OutPatient Clinic under
local anaesthesia and the outcome fluid was collected
aseptically and cultured on Sabouraud’s dextrose agar
with streptphenicol and incubated at 270C for up to 4
weeks and was examined during this period for any fungal
growth. The isolated fungi were identified depending on
colonial appearance (morphology and colour) or the fungal
growth and microscopic examination after staining with
lactophenol cotton blue and Gram’s iodine solution.
Fungal growth was detected in 11 out of the 27 cases
(40.74%).
The commonest fungus detected in our study was
”Aspergillus fumigatus” which was detected in 9 cases
(81.81%), occurring alone in 7 cases and mixed with
”Aspergillus niger” in 2 cases.
The second common aetiologic agent in our study was
”Aspergillus niger” which was detected alone in 1 case
and mixed with” Aspergillus fumigatus” in 2 cases.
The 3rd CODmon aetiologic agent was ”Aspergillus
flavus” Which was detected in only 1 case.
No other fungi were detected.
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from our study, we can conclude that fungus
infection should be born in mind and investigated for in
every case of chronic sinusitis which is resistant to
treatment. This may allow a new route for curing these
cases which were representing a real problem for both the
doctor and the patient because of their resistance to the
traditional methods of treatment.