# Impact of Anatomical Extent and Combined Surgical–Medical Therapy on Survival in Sinonasal and Rhino-Orbito-Cerebral Mucormycosis: A 14-Year Retrospective ENT Cohort

## TL;DR

This study shows that combining surgery and antifungal treatment improves survival in patients with a severe fungal infection affecting the nose and brain.

## Contribution

The study provides new insights into the impact of treatment strategies and disease extent on survival in mucormycosis from a middle-income country ENT cohort.

## Key findings

- Combined surgical and antifungal therapy significantly reduced mortality compared to antifungal therapy alone.
- Patients with isolated sinonasal disease had the highest survival rate (81.8%), while those with rhino-orbito-cerebral disease had the lowest (26.7%).
- Intracranial extension was strongly associated with higher mortality (71.4%).

## Abstract

Background/Objectives: Mucormycosis is a rapidly progressive invasive fungal infection that commonly involves the sinonasal region and skull base in patients with systemic comorbidities, yet robust ENT data from middle-income settings are scarce. Methods: We performed a single-center retrospective review of all patients with histopathologically confirmed mucormycosis treated in the Otorhinolaryngology Department of Dicle University between 2010 and 2023, covering a 14-year period. Eligible patients had paranasal sinus computed tomography at presentation and received surgical and/or systemic antifungal therapy. Demographic data, comorbidities, disease subtype, radiological extent, treatment modality and survival were extracted from records. Survival was estimated using Kaplan–Meier analysis, and group differences were tested with chi-square statistics (p ≤ 0.05). Results: Fifty-two patients met the inclusion criteria (mean age 56.5 ± 15.2 years; 57.7% male); 73.1% had at least one systemic comorbidity, most frequently diabetes mellitus (65.4%) and hematological malignancy (19.2%). Disease was sinonasal in 42.3%, rhino-orbital in 28.8% and rhino-orbito-cerebral in 28.8%. Baseline CT showed intracranial extension in 26.9%. Overall survival was 59.6% and differed markedly by subtype, highest in isolated sinonasal disease (81.8%) and lowest in rhino-orbito-cerebral disease (26.7%). Intracranial extension was associated with higher mortality (71.4% vs. 28.9%). Combined surgical debridement plus systemic antifungal therapy, used in 84.6% of patients, yielded lower mortality than antifungal therapy alone (31.8% vs. 87.5%). Conclusions: In this ENT cohort, prognosis was mainly determined by anatomical extent and treatment strategy. Our findings suggest that timely combined surgical and antifungal management, when feasible and in appropriately selected patients, is associated with improved survival outcomes.