Nonstandard Thinking Required to Meet the Challenge of Complex Sinus Conditions

Panelists agreed diabetes made this case especially challenging since steroid treatment is not well tolerated.

One option is to use debridement, remove fungal spores, and treat the patient with anti-inflammatories, said Dr. Stewart. Another more controversial option would be to do allergy testing and immunotherapy.

Aggressive management should be considered, possibly with a pair of surgeries back to back, said Dr. Palmer. “If you don’t get everything completely and it starts to recur right away, that’s trouble. Hit him hard with steroids, do the surgery. Have the steroids and itraconazole on at the same time,” he said.

Still, even this might only provide mediocre results, showing that even the experts can go only so far.

©2006 The Triological Society