(1221) Outcomes of Hyperbaric Oxygen Therapy in Treatment of Invasive Fungal Sinusitis at a Single Institution

Introduction: Information on the utility of hyperbaric oxygen treatment (HBOT) for invasive fungal sinusitis (IFS) is limited, in part based on the rarity and mortality of the disease. HBOT has been shown to exert antimicrobial, immunomodulatory and angiogenic properties, lending it useful for multiple indications related to hypoxia and infection. In this report, we describe our institutional experience to provide further data as to potential indications for its use in IFS.

Methods: We performed a retrospective case series at an academic tertiary referral center. Review of clinical records from patients treated for IFS with adjunctive HBOT from 2017 to 2022 was conducted. Variables recorded included comorbidities, pathogen, HBOT regimen, complications, additional interventions, and follow-up. Outcomes evaluated were morbidities and mortality.

Results: In our series, 4 patients were identified who had IFS and underwent adjunctive HBOT. All 4 pathogens were identified as Aspergillus and all underwent operative debridement, ranging from 1 to 4 surgeries, as well as treatment with antifungals. Every patient survived and was discharged following HBOT, which ranged from 10 to 28 sessions. One patient was neutropenic upon presentation and required granulocyte infusions throughout HBOT. One patient with a history of heart disease developed pulmonary edema during treatment and 3 required myringotomy placement for barotrauma prophylaxis. Follow-up ranged from 3 to 14 months, all without evidence of recurrence.

Conclusions: HBOT is a safe intervention that should be considered as an adjunct to treatment of IFS. It was found to be particularly beneficial in patients with IFS secondary to aspergillus who do not respond to the standard treatment of surgical debridement and antifungal therapy, or while awaiting recovery of immune function.