Sir Ganga Ram Hospital Doctors perform emergency Sinus surgery on 27-year-old man with Fungal Sinusitis
New Delhi: 27-year-old Dr RG, presented to ENT OPD in an emergent condition with complaints of acute onset vision loss in right eye for 3 days.
He also has history of right-sided nasal obstruction off and on since the last 3 months.
He underwent a CT scan of his sinuses, and he was diagnosed to have nasal polyposis and fungal sinusitis which was compressing the nerve of vision inside the sphenoid sinus. This is a rare condition and if not acted upon soon can lead to complete blindness in the affected eye.
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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, fungus was seen to be spreading in all sinuses and between the nerve and the brain layer in the sphenoid sinus. Complete removal of the disease was achieved, and the nerve was decompressed and freed from the surrounding swollen nasal lining.
Dr Varun Rai stated that these types of surgeries are extremely specialised due to the fact that the optic nerve is very delicate and a 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 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 post operative period his vision improved and gradually returned to normal within 2 days. He was discharged in a stable condition in two days with vision which was completely restored.
Dr Varun Rai, ENT Consultant, SGRH said, “This case serves to highlight the rarity of the condition and the fact that untreated sinusitis can lead to consequences which 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. He also stated that prompt treatment is necessary in such cases and surgeons typically have only a few hours to save the eye in cases of complete blindness.
Dr Manish Munjal, ENT Senior Consultant, SGRH opined that these cases are rare nowadays due to increased awareness and good diagnostic facilities which are readily available. He also mentioned the increased incidence of such cases due to rising pollution levels which leads to nasal allergic responses.
The typical symptoms which patients present with 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.
Sir Ganga Ram Hospital has been at the forefront of innovation and technology and has recently acquired the Image Guided Navigation system where we routinely use real time surgical mapping based on preoperative CT scans to perform nasal surgery in a safe and effective manner. This ensures complete disease clearance in all patients with minimal chances of complications during surgery. SGRH was the first private Hospital in Delhi to start the Navigation Guided Sinus surgery program and has been leading the way in training and teaching programmes around the country.
