Fungal Sinusitis

Sinus disease can be caused by a variety of factors that include both an infectious and inflammatory component.  When caused by fungus, sinusitis can be manifested in a variety of forms causing a wide array of symptoms and disease.  Correctly classifying the type of fungal sinusitis is critical to treatment and long-term symptom control.

Classifications of Fungal Sinusitis

Unfortunately fungus is all around and present throughout our surroundings including the air we breathe. Fortunately however, it is vary rare for fungus to cause severe disease or life threatening infections in a non immunocompromised hosts. Fungal sinusitis can be classified into a variety of subclasses, some of which have been listed below.

Mycetoma (Fungus Ball)

Mycetoma, also known as fungus ball, represents a non invasive form of fungal sinus disease.  It primarily involves an accumulation and growth of fungal elements within one of the paranasal sinuses.  The most common locations include the maxillary sinus (located behind the cheek) and the sphenoid sinus (located behind the eyes). Patients often present with facial pressure and pain, headaches, or visual disturbances.  Treatment often requires removal of the fungal element with endoscopic sinus surgery.

Allergic Fungal Sinusitis

Allergic fungal sinusitis occurs in patients who develop a hypersensitivity allergic reaction  to a group of fungi commonly found in our environment.  The overall occurrence of allergic fungal sinusitis is largely dependent on the region in which you live.  For instance, patients with this form of fungal sinusitis are more likely to live in southern humid environment such as Florida and Texas rather than places such as New York.  Diagnosis is made based on characteristic findings of CT imaging, allergy testing, presence of nasal polyps, and tissue showing fungal debris and eosinophilic mucin within the sinus content.  Treatment requires endoscopic sinus surgery combined with aggressive medical therapy.  Oral anti-fungal treatment is usually not required.

Invasive Fungal Sinusitis

Invasive fungal sinusitis represents a rare form of fungal disease that occurs primarily in patients with a compromised immune system such those with uncontrolled diabetes, leukemia, and patients undergoing chemotherapy or bone-marrow transplantation.  Diagnosis requires clinical suspicion, visualization of necrotic tissue on nasal endoscopy, and confirmation of the invasive fungus on tissue assessment.  Prompt diagnosis and early initiation of treatment are critical to patient outcome as the disease can be rapidly progressive and sometimes fatal.  Treatment often requires extensive surgery and treatment with IV and oral anti fungal medication.

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