Abstract
OBJECTIVES: Granulomatous invasive fungal sinusitis (GIFS) affects immunocompetent individuals. There is ongoing debate over whether surgery, antifungal medication, or a combined approach is the best treatment. This article summarizes reports about GIFS and its management. METHODS: Eight search engines, gray literature, and review articles were searched. Two independent reviewer groups screened the eligibility of articles. An independent reviewer solved disagreements. Exclusion criteria included non-English language reports, papers with unavailable full-texts, reviews, publications before 1980, and studies lacking information about GIFS management. RESULTS: Of the 279 identified articles, 41 studies were included (n = 89 patients). Sinonasal GIFS with skull-base/intracranial extension was associated with an increase in mortality (p = 0.002, OR = 14.083; 95% CI = 1.753-113.157). Treatment was associated with an 87.2% remission rate (p < 0.001, OR = 7.818; 95% CI = 4.502-13.576); a combined medical and surgical approach had a 74.2% recovery rate. Of surgical interventions, the highest recovery rates were associated with endoscopic debulking (52.5%), extensive surgical debulking (32.5%), and open sinonasal approach (15%, p = 0.132). The utilization of voriconazole was associated with higher recovery rates, but this was not significant (76.9 vs. 56%, p = 0.548). CONCLUSION: Sinonasal GIFS with skull-base/intracranial extension is associated with higher mortality rates. The superiority of the endoscopic debulking and voriconazole protocol in managing these cases warrants further investigation. LEVEL OF EVIDENCE: Level 4.