Fungal sinusitis
Fungal Sinusitis
Fungal sinusitis is a rare variant of chronic sinusitis. There are three main type of fungal sinusitis.
- Fungal balls are also known as aspergillomas or mycetomas. These are fungal colonizations, where a fungal spore finds its way into the maxillary or sphenoid sinus and over many years will continue to divide until the sinus is filled. The most common symptoms are nasal drainage or headaches. Commonly the patient is asymptomatic, but has an imaging study for another reason that demonstrates an abnormality. Findings on CT are thickening of the bone surrounding the fungus ball and hyperdensity (i.e. brightness) of the fungus itself. Patients are usually immunocompetent. The treatment is endoscopic sinus surgery to remove the fungus ball, and no systemic antifungal treatment is required. The species of fungus is usually Aspergillus.
- Allergic fungal sinusitis is rare in Reno, but is common in the American South. Patients usually have polyps with thick allergic mucin that looks like peanut butter. Bipolaris is the usual fungal species. On a CT scan the fungal debris will be hyperdense and bony erosion can be seen. Treatment is surgery, with topical steroids after.
- Invasive fungal sinusitis fortunately is rare. This is seen in immunocompromised individuals, from chemotherapy or diabetic ketoacidosis. Mucor is the usual species, and extensive necrosis of the nose and surrounding tissues can occur due to the fungus invading blood vessels that results in tissue death. Treatment is wide surgical excision back to healthy tissue and aggressive antifungal therapy.
Fungal sinusitis is a rare cause of nasal symptoms. Treatment is usually surgical, as apposed to conventional chronic sinusitis. In the case of fungus balls, surgery is usually curative.
Josh Meier, M.D. F.A.R.S.
