Clinical Characteristics of Sphenoid Sinus Fungal Ball Patients With Visual Disturbance

Abstract

ObjectivesA sphenoid sinus fungal ball is a rare disease that can cause visual disturbances. Most afflicted patients remain in an indolent state. However, once the visual disturbance has occurred, the recovery rate is very low. The purpose of this study was to overview the clinical characteristics of patients with a sphenoid sinus fungal ball and ascertain factors possibly related to the occurrence of a visual disturbance.MethodsWe retrospectively reviewed the medical records of all patients who underwent endoscopic sinus surgery for a sphenoid sinus fungal ball at our hospital. We enrolled 47 patients in this study.ResultsOld age and a female predominance were noted. Nasal symptoms were the most common symptom. Eight patients showed visual disturbances. We also compared the clinical characteristics between patients with and without visual disturbances in univariate analysis. Old age, underlying diabetes mellitus, and a sphenoid sinus wall defect visible by computed tomography were factors significantly related to the occurrence of visual disturbances. But only sphenoid sinus wall defect showed significance in multivariate analysis.ConclusionIt is important to prevent complications, such as visual disturbance, in patients with a sphenoid sinus fungal ball. This study describes an early surgical treatment that may be required for patients with a sphenoid sinus fungal ball and particularly patients with a sphenoid sinus wall defect.

Unusual case presentation of fungal ball infection causing diabetes insipidus and seizure disorder

“…They usually present with unilateral headaches that become progressively resistant to painkillers and nasal symptoms like postnasal drip, nasal discharge, cough and cacosmia [3 , 10 , 11] . Visual disturbances and neurological symptoms are rarely reported in these patients [1 , 3] . Patients present with various nonspecific symptoms and complications due to the anatomic characteristics of the sphenoid sinus.…”

“…Fungal rhinosinusitis encompasses a spectrum of infections, commonly affecting the paranasal sinuses. Sinonasal fungus ball is an extramucosal and noninvasive mycotic proliferation that fills one or more paranasal sinuses [1 , 2] . Based on histopathology, it is generally classified into invasive and noninvasive fungal infections.…”

“…Sphenoid sinus FA comprises 4.5%-26.8% of all cases of FA infection [8] . It is usually seen in immunocompetent middle-aged patients, predominantly in females [1] .…”

A Case of Invasive Sphenoid Sinus Aspergillosis Presenting as Oculomotor Nerve Palsy in a Healthy Patient

“… 7) Prompt release of optic nerve compression is also recommended, as visual disturbances in patients have poor treatments outcome in restoring vision. 8) …”

Time equals sight: Sphenoid sinus aspergilloma with vision loss

“…Aspergillus fumigatus is a commonly isolated species, while headache is the main symptom [3] . Vision loss with SSA has poor visual prognosis despite surgical intervention [4] . CT is frequently used, but MRI plays an important role in delineating the involvement of adjunct structures [1] .…”