Sphenoid sinus fungall ball: a retrospective study over a 10- year period

Abstract

A fungal ball consists of a dense conglomerate of fungal hyphae growing at the surface of the sinus mucosa without tissue infiltration. The maxillary sinus is by far the most commonly involved paranasal sinus cavity followed by the sphenoid sinus. The present study is a retrospective study of 25 consecutive cases treated during the last 10 years in the two hospitals be- longing to the Catholic University of Louvain (CHU Mont-Godinne and UCL Saint Luc). We report the symptomatology, the imaging and discuss the different surgical managements. We conclude that the clinician must have a high index of suspicion when dealing with a unilateral rhinosinusitis persisting despite a maximal and well conducted medical treatment. This is particularly so in elderly women when associated with facial pain and post nasal drip, particularly when the computed tomography shows an unilateral opacity of the sphenoid sinus with or without a sclerosis or an erosion of the bony walls, a polyp in the sphenoethmoidal recess or a hyperdensity mimicking a foreign body. An endonasal endoscopic sphenoidotomy is the treatment of choice in most cases, allowing good ventilation of the sinus and radical removal of all the fungal concretion. A biopsy of the sinus mucosa adjacent to fungal elements is of upmost important to confirm the non- invasiveness of the fungi within the tissue. Antifungal medication is not required in uncomplicated forms. All host factors producing some degree of immunosuppression must be corrected when present and must alert the clinician to rule out any forms of invasive disease.

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

“…The reported recurrence rates ranging from 0% to 10%. [3,9,10,[13][14][15][16] In our series only one patient had a recurrence, one year after operation.…”

“…Sclerosis of the sinus wall was the most common CT finding in previous studies. [8][9][10] When there is a suspicion of a fungal disease with or without an intra-cranial or intra-orbital invasion and the CT images are not conclusive for identification of fungal disease, MRI should be used for differential diagnosis.…”

“…[1,2,10] However, culture findings had extremely low sensitivity, previous studies observed a sensitivity ranging from 20.3% to 31.0%. [2,11,12] This difficulty in getting fungi to grow can be attributed to the absence of the fungus ball.…”

10.5937/mckg48-4337 = Non-invasive chronic fungal inflammation of the maxillary sinus mucosa as a cause of long-term cough: Case report

“…Invazivni oblik se javlja kod pacijenata sa oslabljenim imunskim odgovorom, koji su na dugotrajnoj terapiji kortikosteroidima ili boluju od hroničnih sistemskih bolesti (dijabetesa melitusa, Wegenerove granulomatoze, astme, AIDS-a i dr.) (1)(2)(3)(4)(5). On se deli na akutni fulminantni nekrotizujući gljivični rinosinuzitis, hronicni invazivni gljivični rinosinuzitis i granulomatozni gljivični rinosinuzitis (1)(2)(3)(4)(5).…”

“…On se deli na akutni fulminantni nekrotizujući gljivični rinosinuzitis, hronicni invazivni gljivični rinosinuzitis i granulomatozni gljivični rinosinuzitis (1)(2)(3)(4)(5). Glavna histološka karakteristika invazivnih formi jeste da gljivice zahvataju sluzokožu i podsluzokožu, inflitrišu u krvne sudove i liziraju kost.…”