Overview
Fungal sinusitis encompasses various forms including fungus balls (mycetomas), characterized by chronic colonization of sinus cavities without invasive spread, and invasive zygomycosis, which involves aggressive tissue invasion and systemic complications 12.Diagnosis
Clinical Presentation: Symptoms include chronic sinusitis signs, often with localized findings specific to the sinus involved 1.
Imaging: CT scans typically show characteristic findings such as hyperdense, non-enhancing masses in fungus balls 1.
Pathology: Histopathological examination and culture are crucial for confirming fungal presence; Aspergillus species are commonly identified 1.
Endoscopic Examination: Useful for visualizing sinus anatomy and identifying non-invasive fungal masses 1.Management
Surgical Intervention: Primary treatment for fungus balls involves endoscopic sinus surgery or Caldwell-Luc procedures for complete removal 1.
Antifungal Therapy: Adjunctive antifungal medications like amphotericin B may be used, especially in severe or invasive cases 2.
Control of Underlying Conditions: Managing comorbidities such as diabetes is essential, particularly in invasive fungal infections 2.Special Populations
Elderly: Paranasal sinus fungus balls predominantly affect elderly populations with a female predominance 1.
Comorbidities: Patients with uncontrolled diabetes mellitus are at higher risk for severe invasive fungal infections like zygomycosis 2.Key Recommendations
Surgical Removal: Perform surgical removal for definitive treatment of paranasal sinus fungus balls 1 (Evidence: Strong).
Aggressive Combined Therapy: For invasive zygomycosis, employ aggressive combined therapy including surgical debridement and systemic antifungal agents like amphotericin B 2 (Evidence: Moderate).
Manage Comorbidities: Control underlying conditions such as diabetes to prevent severe complications in patients with fungal sinusitis 2 (Evidence: Moderate).References
1 Ferreiro JA, Carlson BA, Cody DT. Paranasal sinus fungus balls. Head & neck 1997. link1097-0347(199709)19:6<481::aid-hed4>3.0.co;2-v)
2 Smith JL, Stevens DA. Survival in cerebro-rhino-orbital zygomycosis and cavernous sinus thrombosis with combined therapy. Southern medical journal 1986. link