Sphenoid sinus fungus ball

Abstract

The objective of this retrospective study is to present a large series of patients with sphenoid sinus fungus ball (SSFB) and describe clinical manifestations, diagnostic workup, surgical treatment, and eventual complications of this disease. We included patients operated on for this disease over a 14-year period. All patients benefited from mid-to-long-term follow-up. There were 28 patients (18 females, 10 males, mean age 64 years). Main symptoms were posterior rhinorrhea and headache. Less common symptoms were alteration of vision or ocular mobility and cacosmia. Preoperative diagnosis was based on nasal endoscopy and CT scanning. MRI was performed in case of suspicion of a tumor, an intraorbital or intracranial invasion. Treatment consisted in endoscopic transnasal or transethmoidal sphenoidotomy with removal of the fungus ball. Specimens were sent to pathology and mycology to confirm diagnosis. Postoperative complications consisted of two cases of epistaxis and two other cases of bacterial superinfection of the operated sphenoid cavity. No recurrence of the fungus ball was seen after a mean follow-up of 13 months. To conclude, SSFB is a relatively uncommon entity, usually due to Aspergillus infection. Although not invasive, if left untreated, it can lead to long-term serious complications. Preoperative nasal endoscopic examination and CT scan are the standard tools for diagnosis. Endoscopic sphenoidotomy with removal of the fungus ball is the current treatment because it has proven effective and has a low morbidity and recurrence rate.

Isolated sphenoid sinus pathologies: a series of 40 cases*

“…To decrease the mortality and morbidity rate with invasive fungal disease, there is a high suspicion for diabetic and immunocompromised patients, where quickly planning surgery and aggressive medical treatment are essential points. We have diagnosed incidentally and not seen visual changes or other symptoms, as stated in the literature (7,9). In the operation, thick, viscous, and black-brown crust was seen in the invasive fungal case.…”

“…With gadolinium application, the signal will increase in the surrounding mucosa but not in a fungus ball (7). CT shows thickening of the mucosa, total or partial heterogeneous opacification and sclerosis, and thickening and osteitis in the surrounding bone.…”

RadIologIcal aspect of fungus ball wIthIn a mucocele of the sphenoId sInus

“…Antifungal medications are generally unnecessary and should be reserved for the immunocompromised patient. Two endoscopic approaches are used to open the sphenoid sinus in case of isolated fungus ball: the transnasal approach and the posterior transethmoidal approach (14).…”

Fungal Biofilms in Human Disease

“…While there is increasing evidence for the role of bacterial biofi lms in this infection, there role of fungi remains controversial (Ebbens et al 2009b ). Paranasal sinus fungus balls have been described (Grosjean and Weber 2007 ;Karkas et al 2012 ), which share some of the features of fungal biofi lms (Harding et al 2009 ;Mowat et al 2009 ). In a recent study of 118 patients with chronic sinusitis, nasal discharge, headache and visual disturbance, over a 14 year period 23.7 % had a sphenoidal fungus ball in which Aspergillus fumigatus and Aspergillus nidulans hyphae were observed microscopically (Karkas et al 2012 ).…”

“…Paranasal sinus fungus balls have been described (Grosjean and Weber 2007 ;Karkas et al 2012 ), which share some of the features of fungal biofi lms (Harding et al 2009 ;Mowat et al 2009 ). In a recent study of 118 patients with chronic sinusitis, nasal discharge, headache and visual disturbance, over a 14 year period 23.7 % had a sphenoidal fungus ball in which Aspergillus fumigatus and Aspergillus nidulans hyphae were observed microscopically (Karkas et al 2012 ). Other fungi have also been implicated including Schizophyllum commune (Chowdhary et al 2013 ;Sa et al 2012 ), Trichosporon inkin (Janagond et al 2012 ), Mucorales (Mignogna et al 2011 ), and Fusarium (Rombaux et al 1996 ) .…”