Proposed computed tomography severity index for the evaluation of invasive fungal sinusitis: Preliminary results

Table 1 Computed tomography severity scoring index

Items	Value
Disease limited to nose/PNS
Mucosal disease in paranasal sinuses	1
Mucosal disease in nasal cavity and nasopharynx	1
Adjacent tissue invasion
Hard palate erosion	1
Soft tissue infiltration anterior/posterior periantral fat	1
Soft tissue infiltration extending to PPF/SOF/IOF/Orbital apex/ITF	2
Significant bilateral disease	2
Orbit
Soft tissue/fat/muscle/NLD involvement	1
Bone erosion	2
Intraocular/optic nerve involvement	3
Intracranial disease
Skull base invasion (erosion)	2
Cavernous sinus involvement	3
Internal carotid artery narrowing/occlusion	3
Intracranial complications (meningitis/cerebritis/abscess/infarct)	3

Mild: 1-8; Moderate: 9-16; Severe: 17-25. PNS: Paranasal sinuses; PPF: Pterygopalatine fossa; SOF: Superior orbital fissure; IOF: Inferior orbital fissure; ITF: Infratemporal fossa; NLD: Nasolacrimal duct.

Table 2 Demographic details

	Parameter	Criteria	n (%)
1	Gender	Male:Female	56 (84.85):10 (15.15)
2	Periorbital swelling	Absent:Present	29 (43.94):37 (56.06)
3	Periorbital pain	Absent:Present	16 (24.24):50 (75.76)
4	Facial numbness	Absent:Present	24 (36.36):42 (63.64)
5	Extra-ocular movements	Normal:Restricted:Frozen	29 (43.94):20 (30.3):17 (25.76)
6	Vision status	Normal:Reduced:FCCF:PL Negative	26 (39.39):21 (31.82):1 (1.52):18 (27.27)
7	Proptosis	Absent:Present	44 (66.67):22 (33.33)
8	Palatal involvement	Absent:Present	45 (68.18):21 (31.82)
9	Cranial nerve Involvement	Absent:Present	48 (72.73):18 (27.27)
10	Ptosis	Absent:Present	39 (59.09):27 (40.91)
11	H/o diabetes	Absent:Present	15 (22.73):51 (77.27)
12	H/o hypertension	Absent:Present	43 (65.15):23 (34.85)
13	HbA1c	< 6.5:≥ 6.5	10 (15.15) 56 (84.85)
14	Side involved	Unilateral:Bilateral	60 (90.91):6 (9.09)
15	CT severity index	Mild (1-8):Moderate (9-16):Severe (≥ 17)	34 (51.52):28 (42.42):4 (6.06)
16	Final organism	Mucormycosis:Aspergillosis:Both	45 (68.18):9 (13.64):12 (18.18)
17	Clinical outcome	Responder:Non-responder	43 (65.15):23 (34.85)
18	Survival	Survived:Expired	56 (84.85):10 (15.15)
19	Diagnosis of COVID-19 before IFS	After:Before	9 (13.63):57 (86.36)
20	Environment	Rural:Urban	20 (30.3):46 (69.7)
21	TALMI staging	Stage 1:Stage 2:Stage 3:Stage 4	2 (3.03):31 (46.97):7 (10.61):26 (39.39)
22	Steroid given for COVID-19 (n = 57)	Not given:Given	24 (42.1):33 (57.89)

CT: Computed tomography; COVID-19: Coronavirus disease 2019.

Table 3 Comparison of severity of disease in different etiological agents, n (%)

Parameter	Subclassification of parameter	Aspergillosis (n = 9)	Mucormycosis (n = 45)	Mixed (n = 12)
Diabetes mellitus		3 (33.3)	37 (82.2)	11 (91.7)
Hypertension		2 (22.2)	16 (35.6)	5 (41.7)
Laterality	Unilateral	9 (100)	40 (89.9)	11 (91.7)
	Bilateral	0 (0)	5 (10.1)	1 (8.3)
CTSI	Mild	7 (77.8)	21 (46.7)	6 (50)
	Moderate	2 (22.2)	21 (46.7)	5 (41.7)
	Severe	0 (0)	3 (6.7)	1 (8.3)
Survival	Survival	8 (88.9)	38 (84.4)	10 (83.3)
	Mortality	1 (11.1)	7 (15.6)	2 (16.7)
Responder/non-responder	Responder	7 (77.8)	27 (60)	9 (75)
	Non-responder	2 (22.2)	18 (40)	3 (25)

CTSI: Computed tomography severity index.

Table 4 Correlation with survival and death

Parameter	Criteria	Survivor	Expired	Total	P value (Fischer's exact test)
Diabetes mellitus	Absent	14	1	15
	Present	42	9	51	0.28
Hypertension	Absent	36	7	43
	Present	20	3	23	0.52
Laterality	Unilateral	54	6	60
	Bilateral	2	4	6	0.004
Organism	Mucormycosis	38	7	45
	Aspergillosis	8	1	9
	Mixed	10	2	12	1
Clinical response	Responder	38	5	43
	Non-responder	18	5	23	0.23
TALMI staging	Stage 1	2	0	2
	Stage 2	29	2	31
	Stage 3	5	2	7
	Stage 4	20	6	26	0.16
CTSI	Mild (1 to 8)	29	5	34
	Moderate (9 to 16)	25	3	28
	Severe (17 or more)	2	2	4	0.12

CTSI: Computed tomography severity index.

Table 5 Correlation with Responder and Non-responder.

Parameter	Criteria	Responder	Non-responder	Total	P value (Fischer's exact test)
Diabetes mellitus	Absent	12	3	15
	Present	31	20	51	0.14
Hypertension	Absent	27	16	43
	Present	16	7	23	0.39
Laterality	Unilateral	42	18	60
	Bilateral	1	5	6	0.02
Organism	Mucormycosis	27	18	45
	Aspergillosis	7	2	9
	Mixed	9	3	12	0.53
Survival	Survivor	38	18	56
	Expired	5	5	10	0.23
TALMI Staging	Stage 1	2	0	2
	Stage 2	22	9	31
	Stage 3	4	3	7
	Stage 4	15	11	26	0.58
CTSI	Mild (1 to 8)	31	3	34
	Moderate (9 to 16)	12	16	28
	Severe (17 or more)	0	4	4	0.00

CTSI: Computed tomography severity index.