Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989–2002

Abstract

Over the last decade, we have observed a high frequency of Aspergillus rhinosinusitis in french medical centers. The epidemiological data, clinical presentations, radiology, mycology and histology results of 173 consecutive patients with paranasal sinus fungus balls who were admitted from 1989 to 2002 have been reviewed. The most common symptoms included purulent nasal discharges and nasal obstructions, with the maxillary sinus being the most common site of infection (152 cases, 87.8%). Computed tomography scans (CT scan) were performed in 92% (159/173) of the cases and heterogeneous opacities were observed in 132 patients (83%). Histology examinations were performed in all cases and proved positive in 162 patients. Fungi were recovered, mainly Aspergillus fumigatus, from samples of 50 patients, while specimens from the remaining 123 patients were negative. Since no specific clinical sign could be found, a diagnosis of fungus ball is frequently made after a long term symptomatic period. CT scan findings of metallic or calcified densities within an opacified sinus cavity are highly suggestive of a fungus ball, but mycological and histological studies are essential to confirm the diagnosis. Treatment consisted of functional endonasal sinus surgery and was successful in 172 out of 173 cases.

Pathology of Fungal Rhinosinusitis: A Review

“…can cause a fungal ball) [1,2]. For unknown reasons, fungal balls are more commonly identified unilaterally in the maxillary sinus in middle aged to elderly females [6,8,9]. Histologically, fungal balls are characterized by entangled masses of fungal organisms or masses of fungi embedded in fibrinous, necrotic exudate, with minimal mucosal inflammatory reaction (Fig.…”

“…However, this confusion is lost on high power which reveals abundant fungal organisms. While prior surgery has been considered a risk factor for fungal ball development, in a recent large study, only one patient had sinonasal surgery prior to the fungal ball development; however an association with prior dental procedures has been proposed [8]. In addition, fungal balls may develop when there are blockages of the sinonasal passages such as the presence of an obstructing neoplasm.…”

“…Fungal cultures are often negative; however the most commonly isolated pathogen is Aspergillus sp. [3][4][5][6][8][9][10][11][12]. Treatment consists of surgical removal of the fungal material without the need for antifungal therapy.…”

Erosive and Expansile Lesion of the Maxillary Sinus by a Sinus Fungus Ball Mimicking Malignancy

“…Thus, a fungus ball can be with difficulty distinguished from air and acute hemorrhage, whereas air can be misinterpreted as fungus ball or chronic inflammation (Som et al, 1990). MRI is a useful tool in case of pansinusitis or involvement of the sphenoid sinus (Dufour et al, 2005).…”

Paranasal sinus fungus ball: analysis of clinical characteristics and surgical outcomes

“…[3][4][5] The reason for this remains unexplained but the aerogenic theory suggests that ethmoid sinus is where inhaled fungus spores accumulate and these become pathogenic when the sinus begins to become anaerobic. Similarly, in our study, paranasal fungus ball was more common in maxillary sinus (75%) than in sphenoid sinus (25%).…”