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Babu AR, Amulya TM, Sandhya D, Premkumar BS, Chandresh S. Decoding the Complexity: A Case Series on Isolated Sphenoid Sinus Fungal Ball. Indian J Otolaryngol Head Neck Surg 2024; 76:3128-3132. [PMID: 39130272 PMCID: PMC11306443 DOI: 10.1007/s12070-024-04627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/08/2024] [Indexed: 08/13/2024] Open
Abstract
Fungal rhinosinusitis accounts for a significant portion of paranasal sinus diseases, with fungus ball being the most frequently observed form, constituting 27% of cases. While commonly affecting the maxillary sinus, sphenoid sinus localization occurred in 24.78% of cases. Managing fungal balls in the sphenoid sinus poses challenges because of their proximity to critical structures, necessitating a careful and effective approach. A retrospective analysis was conducted on patients diagnosed with a paranasal sinus fungal ball, specifically isolated sphenoidal localization. Trans-nasal sphenoidotomy was performed, and the patients were followed up postoperatively for recurrence or residual disease. Among four identified cases, headache was the predominant symptom, and all patients underwent successful endoscopic surgery without complications. The follow-up revealed no recurrence or residual disease. Fungal ball in the sphenoid sinus, although uncommon, present diagnostic challenges with symptoms that often mimic other conditions. CT scans play a crucial role in diagnosis and reveal dense masses with characteristic features. Surgical intervention, particularly endoscopic sphenoidotomy, remains the primary and successful treatment, emphasizing the importance of early detection. This study emphasizes the effectiveness of endoscopic sphenoidotomy for managing isolated sphenoid sinus fungal ball. This also highlights the importance of early detection and treatment to prevent complications. Headache, a primary symptom, was successfully resolved after surgery, reinforcing the role of surgery as the primary treatment.
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Affiliation(s)
- A. R. Babu
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
| | - T. M. Amulya
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
| | - D. Sandhya
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
| | - B. S. Premkumar
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
| | - Swathi Chandresh
- Department of ENT, Head and Neck Surgery, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
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Hafrén L, Saarinen R, Kurimo R, Viljanen M, Lundberg M. Aspergillus Sinusitis: Risk Factors and Phenotyping. J Clin Med 2024; 13:2579. [PMID: 38731108 PMCID: PMC11084900 DOI: 10.3390/jcm13092579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Aspergillus can cause fungal rhinosinusitis (FRS). We aimed to identify risk factors for sinonasal Aspergillus disease. Methods: Patients with a positive sinonasal mycological culture for Aspergillus species diagnosed in our hospital located in a continental climate were included in the 9-year retrospective study. Results: Of the 86 patients, 3 had invasive FRS (IFRS), 51 had fungal ball (FB) disease, and 32 had chronic rhinosinusitis with fungus (CFRS). In the IFRS group, all patients had a malignancy and were immunocompromised. Allergies, allergic rhinitis, asthma, nasal polyps, and the use of inhaled and nasal steroids were more common in the CFRS group, and IgE levels were greater than those in the FB and IRFS groups (p < 0.05). Conclusion: FB disease is a relatively symptom-free single-sinus disease among elderly individuals, and IFRS is dominant among immunocompromised patients. We discovered a third patient group, predominantly with nasal polyps, atopy, asthma, and elevated blood IgE and eosinophils, that did not fulfill the allergic FRS (AFRS) criteria. It is possible that a less fulminant category of underdiagnosed AFRS exists in cold climates. Treatment with local debridement is usually sufficient for FRS, apart from IFRS, and relapses are not common in cold climates.
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Affiliation(s)
- Lena Hafrén
- Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
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Van Ngo C, Nguyen H, Aklinski J, Nguyen DMT, Le HH, Le TTB, Nguyen HQ, Huynh HH, Hanh Nhi LH, Minh LHN. The Combined Middle and Inferior Antrostomy for Fungal Maxillary Sinusitis Treatment. Indian J Otolaryngol Head Neck Surg 2023; 75:2850-2855. [PMID: 37974720 PMCID: PMC10645746 DOI: 10.1007/s12070-023-03863-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/04/2023] [Indexed: 11/19/2023] Open
Abstract
Aims: The objective of this study is to assess the effectiveness of the combined middle and inferior meatal antrostomy (MIMA) in management of patients with maxillary fungal sinusitis. Material and Methods: Design: retrospective cross sectional study. Setting and subjects: From September 2018 to March 2021, fifty-five patients with non-invasive maxillary fungal sinusitis, who underwent transnasal endoscopic combined MIMA. Methods: The study compared patients' pre- and post-operative subjective symptoms, including nasal obstruction, discharge, facial pain or pressure, halitosis, anosmia, and other non-specific symptoms. Endoscopic characteristics of recurrent fungal maxillary sinusitis and postoperative complications were also observed. Closure of the IMA site was evaluated at three and six months post-surgery and patients were categorized into three groups based on closure degree. Results: All clinical symptoms, including nasal discharge, nasal obstruction, nasal pruritus, anosmia, halitosis, sneezing, facial pain, ophthalmic and otologic symptoms, were resolved over six months after combined MIMA in majority of cases (94 - 100%). After three and six months, the postoperative endoscopic evaluation revealed recurrent fungal maxillary sinusitis in 1.8% and 5.4% of cases, respectively. Partial stenosis of the inferior antrostomy was observed in 7.2% and 16% of cases, while complete stenosis was noted in 3.6% and 7.2% of cases after three months and six months. Conclusions: The combined MIMA is effective and has better outcomes than the medial meatal antrostomy approach alone without additional operative time. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03863-6.
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Affiliation(s)
- Cong Van Ngo
- Department of Otolaryngology-Head and Neck Surgery, Cho Ray Hospital, Ho Chi Minh City, 700000 Vietnam
| | - Hoang Nguyen
- Department of Foundation Science, Nova Southeastern University, The Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM), Clearwater, FL 33025 USA
- Department of Preventative Medicine, School of Medicine, University of California at Los Angeles/Charles R. Drew (UCLA), Los Angeles, CA USA
| | - Joseph Aklinski
- Department of Foundation Science, Nova Southeastern University, The Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM), Clearwater, FL 33025 USA
| | - Dung My Thi Nguyen
- Faculty of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000 Vietnam
| | - Hoang Huy Le
- Faculty of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000 Vietnam
| | - Trang Thi Bich Le
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410 USA
| | - Hien Quang Nguyen
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410 USA
| | - Hong-Han Huynh
- School of Biotechnology, Tan Tao University, Long An, Vietnam
- Interdisciplinary and Translational Medicine Internship Training Program, College of Medical Science and Technology, Taipei Medical University, Taipei, 110 Taiwan
- International Master Program for Translational Science, College of Medical Science and Technology, Taipei Medical University, Taipei, 110 Taiwan
| | - Le Huu Hanh Nhi
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410 USA
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000 Vietnam
| | - Le Huu Nhat Minh
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110 Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, 106 Taiwan
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
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A Multi-Institutional Database Review of Orbital Complications and Survival Outcomes in Adult Patients with Invasive or Non-Invasive Fungal Rhinosinusitis. J Fungi (Basel) 2022; 8:jof8121239. [PMID: 36547572 PMCID: PMC9785968 DOI: 10.3390/jof8121239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Invasive fungal rhinosinusitis (IFS) with orbital complications has remained a challenging disease over the past few decades. Only a few studies have been conducted to investigate the factors associated with orbital complications in fungal rhinosinusitis (FRS). We aimed to review the characteristics between IFS and non-invasive fungal rhinosinusitis (NIFS) and determine clinical factors associated with orbital complications and overall survival. METHODS A multi-institutional database review study was conducted using the Chang Gung Research Database (CGRD) from January 2001 to January 2019. We identified FRS patients using International Classification of Diseases diagnosis codes and SNOMED CT. We categorized patients into IFS and NIFS groups and analyzed the demographic data, underlying diseases, clinical symptoms, laboratory data, image findings, fungal infection status, and survival outcomes. RESULTS We included 1624 patients in our study, with 59 IFS patients and 1565 NIFS patients. The history of an organ or hematopoietic cell transplantation had a significant prognostic effect on the survival outcomes, with surgical intervention and high hemoglobin (Hb) and albumin levels recognized as positive predictors. Posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were risk factors of orbital complications. CONCLUSIONS In NIFS patients, orbital complications were found to be associated with old age, a high WBC count, high blood glucose, and a high CRP level. For the risk factors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were recognized as predictors. Among IFS patients, a history of organ or hematopoietic cell transplantation was a risk factor for poor survival, while, conversely, surgical intervention and high Hb and albumin levels were related to improved survival. As predictors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling upon the first visit should raise attention, with close monitoring.
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Alharbi A, Reville N, Molinier S, Bastier PL, de Gabory L. Characterization of fungus ball CT-hyperdensities within maxillary and sphenoid sinuses. Dentomaxillofac Radiol 2022; 51:20180384. [PMID: 35762348 PMCID: PMC10043618 DOI: 10.1259/dmfr.20180384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/10/2022] [Accepted: 06/03/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES CT-scan hyperdensities (HD) are described in more than 60% of all paranasal sinus fungus ball (FB) cases. Two types can be distinguished according to their density: calcium and metal types. We aimed to establish the prevalence and density of the HD observed in sphenoid and maxillary sinus FB and their relation to dental factors. METHODS This retrospective study included 64 patients operated in a tertiary referral center for unilateral maxillary or sphenoid FB diagnosed by histology or mycology. Pre-operative CT scans were analyzed by three independent observers (two ENT and one radiologist). RESULTS There were 45 maxillary FB and 19 sphenoid FB. 63 FB showed HD. Metal-type HD were observed in 28 maxillary FB but not in sphenoid sinuses. Among maxillary FB, the prevalence of endodontic treatment was significantly more significant on the FB side than on the healthy side (p = 0.02). The prevalence of endodontic treatment on the pathological side was more significant in the metal-type group than in the group without metal-type HD (p = 0.01). Isolated calcium-type HD were evidenced in 17 maxillary FB and 18 sphenoid FB (p = 0.019). CONCLUSION This study highlights the existence of two different types of HD in FBs of the paranasal sinuses with an association between metal-type HD and endodontic treatments.
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Affiliation(s)
| | - Nicolas Reville
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Sandrine Molinier
- Radiology and Medical Imaging Department, University Hospital of Bordeaux, Bordeaux, France
| | - Pierre-Louis Bastier
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
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Kim JS, Kwon SH, Kim JS, Heo SJ. Bilateral paranasal sinus fungal balls: A retrospective cohort study in 28 patients over a 21-year period. Medicine (Baltimore) 2022; 101:e30174. [PMID: 35984143 PMCID: PMC9387944 DOI: 10.1097/md.0000000000030174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Paranasal fungal balls are rare entities for which a recent increase in reported cases has been observed. Fungal balls are most commonly unilateral, and there are few bilateral cases in the literature. Here we report the clinical features of bilateral fungal balls in 24 patients treated in our institution over the past 20 years. In this retrospective study, we reviewed the medical records of 5279 patients who underwent endoscopic sinus surgery performed by a single surgeon from January 1996 to December 2016 at a tertiary care center in order to identify patients diagnosed with fungal balls confirmed histopathologically. Demographic data and radiologic findings of patients with bilateral fungal balls were compared with those who had unilateral fungal balls. Multiple logistic regression test was used to compare demographic information between patients with unilateral and bilateral fungal balls. The most commonly involved sinus in bilateral cases was maxillary (87.5%), followed by ethmoid (37.5%) and sphenoid (33.3%). Of the 24 patients, 19 were female, and patient age ranged from 45 to 83 years, with an average of 65.1 years. Common existing comorbidities were hypertension (45.8%), diabetes (29.2%), cardiac problem (16.7%), cerebral infarction (8.3%), pulmonary tuberculosis (8.3%), and lung cancer (4.2%). The clinically relevant features of patients diagnosed with bilateral fungal balls from our review include advanced age and immunocompromised status compared to those with unilateral fungal balls. These features contribute to the clinical distinction of bilateral fungal ball disease from unilateral fungal balls and invasive fungal sinusitis.
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Affiliation(s)
- Jong Seung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sam Hyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung Jae Heo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- *Correspondence: Sung Jae Heo, Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu 41404, Korea (e-mail: )
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The Endonasal Endoscopic Approach to Different Sinonasal Fungal Balls. Int J Otolaryngol 2022; 2022:6721896. [PMID: 35360416 PMCID: PMC8964197 DOI: 10.1155/2022/6721896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Fungal ball sinusitis is a sinonasal fungus ball that usually affects immunocompetent adults with female predominance. The most affected sinus is the maxillary sinus. Aspergillus species is the most typically found fungus. Computed tomography (CT) scan is the gold standard tool in order to diagnose fungal ball sinusitis. The ultimate method for a fungal ball is functional endoscopic sinus surgery (FESS), which has a high success rate and a low morbidity rate. Objective. This study aims to demonstrate the various clinical presentations of fungal ball sinusitis including isolated maxillary sinus, sphenoid sinus, simultaneous occurrence of maxillary and sphenoid fungal ball, and post endonasal endoscopic pituitary surgery fungal ball with various age groups. Also, this study aims to emphasize the importance of early diagnosis and treatment in such cases. Patients and Methods. A retrospective study that was carried in the otorhinolaryngology department of two hospitals: King Fahad Specialist Hospital and Qatif Central Hospital, Eastern Region, Saudi Arabia. The study was conducted on a total of 16 patients who were diagnosed with paranasal sinuses fungal ball in an 11-year period from January 2008 and November 2019. Results. Out of 16 patients with paranasal sinuses fungal ball, 11 cases were female and 5 males, with age ranging between 16 and 46 years. Results showed eight isolated sphenoid (50%), six isolated maxillary fungal ball (38%), one simultaneous occurrence of the sphenoid and maxillary fungal ball (6%), and one post endonasal endoscopic pituitary surgery for pituitary adenoma (6%). CT scan was performed for all 16 cases which is the standard tool for the diagnosis of the fungal ball. Conclusion. Fungal ball may present with variety of symptoms but most commonly with postnasal discharge (PND), headache, and facial pain. CT sinuses is the diagnostic radiological modality to confirm the diagnosis. The FESS functional endoscopic sinus surgery is the gold safe approach for patients with fungal ball to manage their symptoms, confirm the diagnosis, and removal of disease with no morbidities.
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Spatola A, Aspromonte M, Marino MA, Miano SM, Zagaria A, Galletti B, Blandino A, Ascenti G, Sofia C. Fungal ball in concha bullosa as incidentaloma: A case report and the review of the literature. Radiol Case Rep 2022; 17:997-1001. [PMID: 35106112 PMCID: PMC8789509 DOI: 10.1016/j.radcr.2021.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022] Open
Abstract
Concha bullosa is an anatomic variant consisting in an enlargement and pneumatization of the middle nasal turbinate. A fungal ball (FB) localized in this structure is an extremely rare disease. This article describes the unusual case of a young patient with an asymptomatic fungal mass in the concha bullosa, incidentally discovered at computed tomography (CT) scan of the head, which was performed after trauma.
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Kim KS, Kim BK, Chung MJ, Cho HB, Cho BH, Jung YG. Detection of maxillary sinus fungal ball via 3-D CNN-based artificial intelligence: Fully automated system and clinical validation. PLoS One 2022; 17:e0263125. [PMID: 35213545 PMCID: PMC8880900 DOI: 10.1371/journal.pone.0263125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study aims to develop artificial intelligence (AI) system to automatically classify patients with maxillary sinus fungal ball (MFB), chronic rhinosinusitis (CRS), and healthy controls (HCs). Methods We collected 512 coronal image sets from ostiomeatal unit computed tomography (OMU CT) performed on subjects who visited a single tertiary hospital. These data included 254 MFB, 128 CRS, and 130 HC subjects and were used for training the proposed AI system. The AI system takes these 1024 sets of half CT images as input and classifies these as MFB, CRS, or HC. To optimize the classification performance, we adopted a 3-D convolutional neural network of ResNet 18. We also collected 64 coronal OMU CT image sets for external validation, including 26 MFB, 18 CRS, and 20 HCs from subjects from another referral hospital. Finally, the performance of the developed AI system was compared with that of the otolaryngology resident physicians. Results Classification performance was evaluated using internal 5-fold cross-validation (818 training and 206 internal validation data) and external validation (128 data). The area under the receiver operating characteristic over the internal 5-fold cross-validation and the external validation was 0.96 ±0.006 and 0.97 ±0.006, respectively. The accuracy of the internal 5-fold cross-validation and the external validation was 87.5 ±2.3% and 88.4 ±3.1%, respectively. As a result of performing a classification test on external validation data from six otolaryngology resident physicians, the accuracy was obtained as 84.6 ±11.3%. Conclusions This AI system is the first study to classify MFB, CRS, and HC using deep neural networks to the best of our knowledge. The proposed system is fully automatic but performs similarly to or better than otolaryngology resident physicians. Therefore, we believe that in regions where otolaryngology specialists are scarce, the proposed AI will perform sufficiently effective diagnosis on behalf of doctors.
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Affiliation(s)
- Kyung-Su Kim
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Byung Kil Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Bin Cho
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Beak Hwan Cho
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (YGJ); (BHC)
| | - Yong Gi Jung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (YGJ); (BHC)
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Luizeti BO, Lima LARD, Spies JW, Sella GCP. Rare Presentations of Frontal Sinus Fungus Ball: A Systematic Review. Int Arch Otorhinolaryngol 2022; 26:e738-e743. [DOI: 10.1055/s-0041-1740598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction The sinus fungus ball is an agglomeration of debris and hyphae, mainly caused by Aspergillus fumigatus, within the paranasal sinus, commonly affecting a single sinus, and it only rarely affects the frontal sinus.
Objective To identify the state of the art of fungus ball in paranasal sinuses, especially related to the epidemiology of the disease in the frontal sinus. Additionally, this article reports a rare case of fungus ball in the frontal sinus in an adult male, and discusses the variables of this condition related to the patient.
Data Synthesis All of the 8 cases of fungus ball in the frontal sinus reported in this study affected male patients: 40% had unilateral disease, and 60%, bilateral disease, contrary to the incidence data of fungus ball in the other paranasal sinuses, which reports unilateral prevalence. However, in the present study, this index changes, with 50% of unilateral and 50% of bilateral incidence regarding frontal sinus involvement. The average age of the patients was 65.36 years (range: 60-74 years). The etiologic agent was Aspergillus spp., and the endonasal endoscopic therapeutic approach corresponded to 80% of cases, while frontal osteoplasty accounted for 20% of cases, reaffirming the prevalence data from other studies.
Conclusion Despite being a low-incidence entity, frontal sinus fungus ball should be considered in patients with pain in the frontal region refractory to the usual clinical treatments.
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Affiliation(s)
| | - Lesley Ane Roks de Lima
- Department of Medicine, Faculdade de Medicina, Universidade Cesumar, Maringá, Paraná, Brazil
| | - Jonas Willian Spies
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, São Paulo, Brazil
| | - Guilherme Constante Preis Sella
- Department of Medicine, Faculdade de Medicina, Universidade Cesumar, Maringá, Paraná, Brazil
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, São Paulo, Brazil
- Academia Brasileira de Cirurgia Plástica da Face (ABCPF), São Paulo, São Paulo, Brazil
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Clinical features in maxillary sinus fungus ball in patients with malignant hematological disease. Eur Arch Otorhinolaryngol 2021; 279:1919-1927. [PMID: 34216265 DOI: 10.1007/s00405-021-06973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies on fungus balls have primarily focused on immunocompetent patients, and only a few studies have described the clinical characteristics of fungus balls in malignant hematological disease (MHD) patients. Therefore, we compared the clinical features of maxillary sinus fungus ball (MSFB) between immunosuppressive patients with MHD and immunocompetent patients. METHODS Twenty patients with MHD and 40 randomly selected immunocompetent patients were enrolled and divided into MHD and non-MHD groups. All patients were diagnosed with MSFB and their clinical features were retrospectively analyzed. RESULTS Patients in the MHD group had non-specific clinical symptoms and endoscopic manifestations of MSFB, similar to those in the non-MHD group. On computed tomography (CT), the MHD group showed higher Lund-Mackay scores, lesser single sinus opacifications, more multiple sinus opacifications on the affected side, and more bilateral opacifications compared to the non-MHD group. The MHD group had a lower frequency of central hyper-density and heterogeneous opacifications than the non-MHD group. There were no significant differences between the two groups in terms of the fungal-infected side, lateral sinus wall ratio, sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and nasal septum deviation. CONCLUSION The clinical symptoms and endoscopic manifestations of MSFB in patients with MHD were similar to those of immunocompetent patients. However, more atypical signs and wider mucosal inflammation were found on CT scans of MSFB patients with MHD. These results indicate that caution should be executed when excluding the possibility of fungus balls in immunosuppressive patients.
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Raiesi O, Hashemi SJ, Mohammadi Ardehali M, Ahmadikia K, Getso MI, Pakdel F, Rezaie S, Dai Ghazvini R, Khodavaisy S, Gerami Shoar M, Borjian Boroujeni Z. Molecular identification and clinical features of fungal rhinosinusitis: A 3-year experience with 108 patients. Microb Pathog 2021; 158:105018. [PMID: 34098021 DOI: 10.1016/j.micpath.2021.105018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/24/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
This study aimed to determine the prevalence, the causative agents, clinical features, and the risk factors associated with the fungal rhinosinusitis in a tertiary health center with a view to providing valid grounds that may guide healthcare professionals to effectively prevent, control, and treat fungal infections. All patients were subjected to diagnostic nasal endoscopy and CT scan of paranasal sinuses and FRS were confirmed by routine and complementary mycological and molecular methods. The inclusion criteria for invasive FRS were: confirmed diagnosis of IFRS according to the guidelines of the EORTC/MSG criteria (i.e., clinical, microbiological, and histological evidence of invasive fungal infection). From a total of 512 suspected patients, FRS was confirmed in 108 cases (21.1%). Our results showed FB (38/108; 35.2%) is the most common form of FRS followed by AIFRS (33/108; 30.6%), AFS (32/108; 29.6%), and CIFRS (5/108; 4.6%). A. flavus and Rhizopus oryzae were the most common causes of infection in AFS, FB, CIFRS, and AIFRS, respectively. Univariate analysis of variables predictive of AIFRS revealed 3 variables significantly associated with AIFRS. These included mucosal abnormalities of the middle turbinate and septum, and specifically, necrosis of the middle turbinate (P < .0001). Microbiological cultures, although useful for mycological speciation, are less sensitive. Furthermore, we used molecular methods to confirm the identity of some isolates that were not detectable using routine methods. Our data showed that the molecular methods and histologic diagnosis in all patients were more sensitive than the unenhanced sinus CT scan, and conventional microbiological methods.
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Affiliation(s)
- Omid Raiesi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mojtaba Mohammadi Ardehali
- Department of Otorhinolaryngology, School of Medicine, Tehran University of Medical Sciences, Amiralam Hospital, Tehran, Iran
| | - Kazem Ahmadikia
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero, University Kano PMB, 3011, Kano-Nigeria
| | - Farzad Pakdel
- Ophthalmic Plastic & Reconstructive Surgery Department, Farabi Hospital, Tehran University of Medical Sciences, Vice Chair of Iranian Research Association for Vision and Ophthalmology (IRAVO), Iran
| | - Sassan Rezaie
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Dai Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Gerami Shoar
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Borjian Boroujeni
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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A Rare Cause of Headache That Should Be Kept in Mind: Isolated Concha Bullosa Fungus Ball. J Craniofac Surg 2021; 31:e550-e552. [PMID: 32371686 DOI: 10.1097/scs.0000000000006477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Concha bullosa is characterized by pneumotization of the middle turbinate and is a common variation of sinonasal anatomy and is often asymptomatic. The presence of a fungus ball in concha bullosa and the associated clinic symptoms are very rare. Concha bullosa fungus balls are a rare differential diagnosis in a patient presenting to the otorhinolaryngology outpatient clinic with headache.In this article, the authors aimed to present an isolated fungus ball case in concha bullosa as a rare cause of headache differential diagnosis.
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14
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Capek S, Carpenter D, Mattos J, Maggio D, Jane JA, Syed HR. Compressive epidural collection as an unusual complication of FESS for a pediatric mycetoma. Childs Nerv Syst 2021; 37:311-314. [PMID: 32409960 DOI: 10.1007/s00381-020-04651-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022]
Abstract
Functional endoscopic sinus surgery (FESS) is a treatment of choice for fungal sinus ball (mycetoma), which is considered safe with a very low major complication rate. We present an unusual case of a 12-year-old female, who underwent FESS for a sphenoid sinus mycetoma and which was complicated by an acute, compressive epidural fluid collection. This presumably resulted from sinus irrigation in the setting of an under-appreciated skull base and mucosal defects causing a ball-valve effect. Our patient had a temporary neurologic deficit with complete recovery, however, similar complications can have fatal consequences.
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Affiliation(s)
- Stepan Capek
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
- 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Delaney Carpenter
- Department of Otolaryngology, University of Virginia, Charlottesville, VA, USA
| | - Jose Mattos
- Department of Otolaryngology, University of Virginia, Charlottesville, VA, USA
| | - Dominic Maggio
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - John A Jane
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Hasan R Syed
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
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15
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Li H, Wu YX, Wang M, Xing ZM, Han L. Comparison Between Multiple and Solitary Fungus Balls: A Retrospective Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP459-NP467. [PMID: 33337251 DOI: 10.1177/0145561320982188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The most common type of noninvasive fungal rhinosinusitis is fungus ball (FB), which usually involves a solitary paranasal sinus. Multiple fungus balls (MFBs) are rarely reported in literature. The purpose of this study was to analyze and compare the clinical features of MFBs and solitary fungus ball (SFB). METHODS We retrospectively investigated consecutive cases of FB between 2001 and 2018 and compared the clinical records of SFB with MFBs with respect to demographics, clinical features, location, radiological findings, and operative outcome. RESULTS A total of 440 SFB and 43 MFBs cases were included in the study. The mean age was 55.3 ± 13.3 and 60.6 ± 10.9 years, respectively (P = .011). The incidence of MFBs obviously increased from 2001 to 2018. The clinical symptoms and laboratory examination were similar. On computed tomography images, complete opacification, septal deviation, Haller cells, and obstruction of ostiomeatal complex were more common (P < .05). The incidence of SFB on the left and right sides was similar, while MFBs were seen to involve both sides in 74.4%. CONCLUSIONS Compared with SFB, MFBs showed some special characteristics. The MFBs affected older patients showed wide range of lesions and complex anatomy. Surgical technique is very important. Much more attention should be paid to this not so uncommon disease during the perioperative period.
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Affiliation(s)
- Hui Li
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Yu-Xiao Wu
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Min Wang
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhi-Min Xing
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Lin Han
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
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16
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Fungal ball of the maxillary sinus and the risk of persistent sinus dysfunction after simple antrostomy. Am J Otolaryngol 2020; 41:102541. [PMID: 32466983 DOI: 10.1016/j.amjoto.2020.102541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Maxillary sinus fungal ball is a common cause of unilateral maxillary sinusitis. Fungal balls or mycetomas are primarily treated with surgery to remove the fungus. However, this assumes the pre-fungal ball sinus cavity was normal and post-surgery patients may suffer from mucostasis in the sinus cavity with persistent symptoms. It is proposed that fungal balls are potentially a feature of impaired mucus clearance as they are a pathology in their own right. METHODS A case series of consecutive patients undergoing antrostomy for maxillary sinus fungal ball was performed. Patient factors including age, gender, smoking status, comorbidities (allergy, asthma, and reflux), disease specific factors including duration of symptoms, microbiology (bacterial co-infection, Gram-positive and/or Gram-negative) and preoperative radiologic findings (extent of sinus development, and neo-osteogenesis/bone thickness) were collected. The primary outcome was sinus function defined by evidence of a normal functioning maxillary sinus, with the absence of mucostasis or pooling, on endoscopic exam at three months, six months and last follow-up. Endoscopic evaluation of inflammation was also collected. RESULTS 28 patients (age 58.5 ± 15.5 years, 64.3% female) were assessed. Mucostasis was present at three months in 39.3%, at six months in 32.1%, and 17.9% at last follow-up. There was no comorbidity or radiologic finding that was associated with failure to normalize. Those patients with mucostasis had a higher modified Lund-Mackay endoscopic score at last follow-up (5.0 ± 0.7 v 0.2 ± 0.6, p < 0.01). CONCLUSIONS Long term post-operative mucostasis occurred in 17.9% of patients following an adequate maxillary antrostomy for treatment of a fungal ball. Patients with mucostasis had persistent mucosal inflammation and a greater need for further surgery (modified medial maxillectomy).
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17
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Kim YY, Yang HC, Kim JG, Kim HY, Park JM, Nam KI, Song MK, Lim SC. The Antibiotic-Vaseline Soaked Cotton Pledget as an Adjuvant Material for Endoscopic Endonasal Fungal Ball Removal. JOURNAL OF RHINOLOGY 2020. [DOI: 10.18787/jr.2019.00285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background and Objectives: Treatment choice for fungal ball is endoscopic endonasal removal. However, it is not easy to remove fungal elements from the maxilla using only an endonasal approach. To overcome this difficulty, we introduced a cotton pledget technique and evaluated its efficacy through a cadaveric study and clinical research.Materials and Method: A cadaveric study was performed using 10 half heads of seven cadavers. The ease and safety of the cotton pledget technique were compared to those of a previously reported technique. In clinical research, we enrolled 52 patients who underwent surgery with the cotton pledget technique and 36 patients who underwent surgery using the conventional endoscopic approach. Demographic factors, preoperative Lund-Mackay (LM) score, sinonasal outcome test (SNOT) score, surgical morbidity, and incomplete removal rate were analyzed.Results: The cadaveric study showed that the cotton pledget technique was easier (p=0.011) than the conventional technique. In addition, clinical evaluation showed that the cotton pledget group had significantly lower incomplete removal rate than that of the control group (p=0.010).Conclusion: The cotton pledget technique is an easy and safe method that enables fungal ball removal more effectively than the conventional technique without need for inferior meatal antrostomy (IMA) or the Caldwell-Luc (CL) approach.
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18
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TOMRUKÇU D, KÖSE T, DURSUN E. Maxillary sinus fungus ball: a case report. ACTA ODONTOLOGICA TURCICA 2020. [DOI: 10.17214/gaziaot.621595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Cha H, Song Y, Bae YJ, Won TB, Kim JW, Cho SW, Rhee CS. Clinical Characteristics Other Than Intralesional Hyperdensity May Increase the Preoperative Diagnostic Accuracy of Maxillary Sinus Fungal Ball. Clin Exp Otorhinolaryngol 2019; 13:157-163. [PMID: 31674170 PMCID: PMC7248610 DOI: 10.21053/ceo.2019.00836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/04/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives This study aimed to evaluate the clinical characteristics of maxillary sinus fungus ball (MFB) to increase the preoperative diagnostic accuracy. Methods A retrospective review of 247 patients who underwent endoscopic sinus surgery for unilateral maxillary sinusitis from January 2015 to December 2017 at a single institution was performed. Patients with pathologically proven MFB were compared to those with unilateral chronic maxillary sinusitis (CMS). Patient demographics and computed tomography (CT) findings were evaluated. The CT features were categorized as intralesional hyperdensity (calcification), the irregular lobulated protruding lesion (fuzzy appearance), maxillary sinus full haziness without mass effect, maxillary sinus full haziness with mass effect, and others. A regression tree analysis was performed. Results In total, 247 patients were analyzed; among them, 179 (72.5%) had MFB and 68 (27.5%) had CMS. MFB showed predominance in older individuals. Among the radiological features, intralesional hyperdensity was most commonly associated with MFB. The presence of a fuzzy appearance or full opacity with mass effect was also associated with MFB. The highest area under the curve was noted with the regression tree analysis based on the model, which included the presence of intralesional hyperdensity, demographic data (age), and presence of fuzzy appearance or maxillary sinus full haziness with mass effect in case of absence of intralesional hyperdensity (0.904). Conclusion A simple algorithm to optimize the preoperative diagnosis of MFB was developed. Physicians should be aware of such findings in the management of patients presenting with unilateral CMS.
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Affiliation(s)
- Hyunkyung Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjae Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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20
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Asymptomatic Radio-Opacity at the Floor of Nasal Cavity. Indian J Otolaryngol Head Neck Surg 2019; 71:1816-1820. [DOI: 10.1007/s12070-017-1179-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/11/2017] [Indexed: 10/18/2022] Open
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21
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Costa F, Emanuelli E, Franz L, Tel A, Sembronio S, Robiony M. Fungus ball of the maxillary sinus: Retrospective study of 48 patients and review of the literature. Am J Otolaryngol 2019; 40:700-704. [PMID: 31239183 DOI: 10.1016/j.amjoto.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maxillary fungus ball (FB) is the most frequent paranasal localization. OBJECTIVE To review clinical presentation, surgery and results of treatment in our series of patients with maxillary FB. To review the literature concerning treatment of maxillary FB. PATIENTS AND METHODS 48 patients with a diagnosis of maxillary FB were treated with endoscopic sinus surgery (ESS) alone or in association with external approaches. Before surgery all patients received computed tomography (CT), nasal endoscopy and dental examination. All the patients were followed for 1 year after surgery. Studies concerning surgical treatment of maxillary FB from 2006 were reviewed. RESULTS The mean age of patients was 53.6 ± 11.9 years. 20 patients (41.6%) did not present any symptom, 19 patients (39.7%) had nasal symptoms, 3 patients (6.2%) had facial pain, 6 patients (12.5%) had a combination of both. Endoscopic examination was positive in 31 patients (64.6%), 17 patients (35.4%) showed negative findings. Logit regression model demonstrated that clinical symptoms contribute to the prediction of a positive endoscopic examination. 25 patients (52.1%) presented odontogenic factors. Complete clinical and radiological resolution of FB was observed in 46 patients (95.8%). CONCLUSIONS Comparing our sample to the studies reviewed we may concluded that odontogenic factors were frequently reported and should be treated at the same time of maxillary FB. ESS alone or in association with external approaches is an effective treatment for patients with maxillary FB.
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Affiliation(s)
- Fabio Costa
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria of Udine, Udine, Italy.
| | - Enzo Emanuelli
- Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera - Policlinico of Padova, Padova, Italy
| | - Leonardo Franz
- Azienda Ospedaliera - Policlinico of Padova, Padova, Italy
| | - Alessandro Tel
- Azienda Ospedaliero Universitaria of Udine, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria of Udine, Udine, Italy
| | - Massimo Robiony
- Azienda Ospedaliero Universitaria of Udine, Department of Medical and Biological Science, University of Udine, Udine, Italy
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22
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Liu X, Liu C, Wei H, He S, Dong S, Zhou B, Zhang L, Li Y. A retrospective analysis of 1,717 paranasal sinus fungus ball cases from 2008 to 2017. Laryngoscope 2019; 130:75-79. [PMID: 31466130 DOI: 10.1002/lary.27869] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/20/2019] [Accepted: 01/28/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Xin Liu
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Chengyao Liu
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Hongzheng Wei
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Shuai He
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Shouxiang Dong
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Bing Zhou
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Luo Zhang
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
- Beijing Key Laboratory of Nasal DiseasesBeijing Institute of Otolaryngology Beijing China
| | - Yunchuan Li
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
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23
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Reconstructive Surgery for Mycetoma: Is There a Need to Establish an Algorithm? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2197. [PMID: 31321187 PMCID: PMC6554160 DOI: 10.1097/gox.0000000000002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 11/16/2022]
Abstract
Background: Mycetoma is a chronic, progressive, disfiguring, and destructive disease. It caused by a variety of microorganisms including fungi and higher bacteria. It is primarily an infection of the skin and soft tissue, most frequently affecting the lower extremity and the hand and spread through fascial planes and lymphatics. Methods: Current medical and surgical management are still inadequate and the recurrence rate is high with severe disabilities. Results: This review describes some reconstructive techniques that were performed to address essential aspects with regard to mycetoma surgical management that include coverage of large skin and soft-tissue defects left after local excisions, enhancing the rate of chronic mycetoma wound healing, and preservation or restoration of functional status of the affected limbs. Conclusion: These applied techniques—which had acceptable preliminary outcome—have to be considered by the surgeons dealing with mycetoma to improve the functional and cosmetic outcomes and to minimize tremendous morbidities and disabilities that are associated with this neglected disease.
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24
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Kimura M, Enomoto A, Maenishi O, Chikugo T, Sugita T. A fungal ball within a maxillary sinus with dental root canal filler and rare fungal propagules. Pathol Int 2019; 69:360-365. [PMID: 31215141 DOI: 10.1111/pin.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/20/2019] [Indexed: 11/25/2022]
Abstract
A fungal ball of a maxillary sinus sometimes includes dental treatment-related foreign material because the sinus is close to the root of the upper teeth. We present a case of right maxillary sinus fungal ball with a gutta-percha point, a dental root canal filler. X-ray analysis of the foreign material in the paraffin section of the fungal ball successfully detected zinc, sulfur, and barium, all of which were constituents of the gutta-percha point. The gutta-percha point might have facilitated the formation of the fungal ball through disruption of the sinus-clearing mechanism. Another interesting histological feature of the fungal ball was the finding of calcium oxalate crystals and non-hyphal fungal elements such as cleistothecia, Hülle cells, and conidial heads. This is the first report of such a combination being found in a specimen of human fungal disease. Although fungal culture was not available in the present case, molecular analysis of the formalin-fixed paraffin-embedded tissue of the fungal ball succeeded in revealing only DNA sequences of Aspergillus nidulans and some other environmental Aspergillus spp.
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Affiliation(s)
- Masatomo Kimura
- Department of Pathology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Akifumi Enomoto
- Department of Oral and Maxillofacial Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Osamu Maenishi
- Department of Pathology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takaaki Chikugo
- Department of Pathology, Kindai University Faculty of Medicine, Osaka, Japan.,Center for General Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takashi Sugita
- Department of Microbiology, Meiji Pharmaceutical University, Tokyo, Japan
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25
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Ahn SH, Lee EJ, Hong MP, Shin GC, Kim KS. Comparison of the clinical characteristics of bilateral and unilateral fungal balls in Korea. Eur Arch Otorhinolaryngol 2019; 276:1975-1980. [DOI: 10.1007/s00405-019-05408-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/25/2019] [Indexed: 01/09/2023]
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26
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Radulesco T, Varoquaux A, Ranque S, Dessi P, Michel J, Cassagne C. Maxillary fungus balls due to Fusarium proliferatum. J Mycol Med 2019; 29:59-61. [PMID: 30738735 DOI: 10.1016/j.mycmed.2019.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 12/01/2022]
Abstract
Fungus ball is the most common form of non-invasive fungal rhinosinusitis. Aspergillusfumigatus (between 44.8% and 75%) and Aspergillusflavus (14%) are the two most common species recovered. However, recent advances in mycological laboratory methods have enhanced the detection and identification of fungi within fungus balls. Fusarium species, sometimes recovered from other forms of fungal rhinosinusitis such as allergic fungal rhinosinusitis or acute invasive fungal rhinosinusitis, are poorly associated with sinonasal fungus ball. Here, we describe two further cases of a fungus ball due to Fusariumproliferatum and provide the first description of this fungal pathogen with a fungus ball of odontogenic origin. These case reports demonstrate that uncommon fungal species such as Fusarium spp. might be underestimated as agents of sinusal cavity fungus ball. Enhanced mycological detection and diagnostic techniques might give rise, in the near future, to the emergence of new or rare fungal species associated with this clinical entity.
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Affiliation(s)
- T Radulesco
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Assistance publique-hôpitaux de Marseille, 13385 Marseille cedex, France; CNRS, IUSTI, Aix-Marseille Université, 13453 Marseille, France.
| | - A Varoquaux
- Department of Radiology, La Conception University Hospital, Assistance publique-hôpitaux de Marseille, 13385 Marseille cedex, France
| | - S Ranque
- SSA, IRD, IHU - Méditerranée Infection, VITROME, Aix-Marseille Université, AP-HM, 13005 Marseille, France
| | - P Dessi
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Assistance publique-hôpitaux de Marseille, 13385 Marseille cedex, France
| | - J Michel
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Assistance publique-hôpitaux de Marseille, 13385 Marseille cedex, France; CNRS, IUSTI, Aix-Marseille Université, 13453 Marseille, France
| | - C Cassagne
- SSA, IRD, IHU - Méditerranée Infection, VITROME, Aix-Marseille Université, AP-HM, 13005 Marseille, France
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27
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Bois E, Boucenna M, Sain-Oulhen C, Lecanu JB. Fungus Ball of the Middle Ear: A Case Study. OTO Open 2018; 1:2473974X17746582. [PMID: 30480201 PMCID: PMC6239154 DOI: 10.1177/2473974x17746582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 09/29/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Emilie Bois
- Department of Otolaryngology-Head and Neck Surgery, Institut Arthur Vernes, Paris, France
| | - Malika Boucenna
- Department of Radiology, Institut Arthur Vernes, Paris, France
| | - Charlotte Sain-Oulhen
- Department of Otolaryngology-Head and Neck Surgery, Institut Arthur Vernes, Paris, France
| | - Jean-Baptiste Lecanu
- Department of Otolaryngology-Head and Neck Surgery, Institut Arthur Vernes, Paris, France
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Naros A, Peters JP, Biegner T, Weise H, Krimmel M, Reinert S. Fungus Ball of the Maxillary Sinus-Modern Treatment by Osteoplastic Approach and Functional Endoscopic Sinus Surgery. J Oral Maxillofac Surg 2018; 77:546-554. [PMID: 30448431 DOI: 10.1016/j.joms.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Functional endoscopic sinus surgery (FESS) is considered standard surgical therapy for fungus ball of the maxillary sinus. However, recent findings have indicated an odontogenic etiology, which requires simultaneous treatment of the dental origin. This study presents the authors' treatment results of fungus ball of the maxillary sinus using a combination of FESS and an endoscopically assisted osteoplastic approach through the anterior wall of the maxillary sinus, enabling simultaneous treatment of the dental origin. MATERIALS AND METHODS A cohort of 22 patients with histopathologically confirmed fungus ball of the maxillary sinus was retrospectively analyzed. Clinical records and medical imaging data were reviewed to evaluate the etiology, clinical and radiologic findings, and postoperative outcome. RESULTS Only 15 patients presented nonspecific clinical symptoms compatible with chronic unilateral maxillary sinusitis. Computed tomography visualized complete opacity of the maxillary sinus in 11 patients and intralesional hyperdensity in 12 patients. An odontogenic association was verified in 18 patients. Twenty-one patients underwent endoscopically assisted osteoplastic surgery through the anterior maxillary sinus wall. In 12 cases, the assumed persistent odontogenic source was treated simultaneously. Depending on the patency of the ostiomeatal complex, the accompanying chronic sinusitis was treated by FESS. CONCLUSIONS The present data support the assumption of an odontogenic etiology of fungus ball of the maxillary sinus. Hence, surgical management requires simultaneous treatment of the fungal mass, the odontogenic origin of the disease, and the accompanying chronic sinusitis. To properly treat fungus ball, the authors present a modern treatment concept, using a minimally invasive endoscopically assisted osteoplastic approach through the anterior maxillary wall, for sufficient and necessary surgical treatment.
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Affiliation(s)
- Andreas Naros
- Resident, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany.
| | - Jens Peter Peters
- Medical Specialist, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Thorsten Biegner
- Resident, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Hannes Weise
- Medical Specialist, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Michael Krimmel
- Vice Chairman, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Siegmar Reinert
- Department Head, Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Tuebingen, Germany
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29
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Jiang RS, Huang WC, Liang KL. Characteristics of Sinus Fungus Ball: A Unique Form of Rhinosinusitis. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2018; 11:1179550618792254. [PMID: 30090023 PMCID: PMC6077877 DOI: 10.1177/1179550618792254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/10/2018] [Indexed: 11/26/2022]
Abstract
Objective: The purpose of this study was to investigate the characteristics of this unique form of rhinosinusitis. Methods: Ninety-one patients with sinus fungus balls were evaluated for clinical characteristics. Nasal tissues obtained from 38 patients with sinus fungus ball, along with 26 controls were used for histopathological, cytokines/chemokines, western blotting, and genetic analyses. Results: Patients with fungus balls had significantly more females and their age was older. The presentation of fungus ball was predominantly unilateral (97.8%). Thirty-three patients (36.3%) had risk factors for fungal infection. Macrophage and neutrophil dominated cellular infiltration was found in nasal tissues of fungus ball patients. A tendency of reduced tight junction staining (e-cadherin) and protein expression was found. Interleukin 8 (IL8) and granulocyte colony stimulating factor (G-CSF) significantly increased in sinus fungus ball tissue homogenates when compared with those from controls. Higher prevalence of a single single nucleotide polymorphism (SNP) with E-cadherin was found in the patients with fungus ball. Conclusions: We found that patients with sinus fungus ball had robust immune responses, allowing recruitment and activation of macrophages and neutrophils. However, patients with sinus fungus ball could have genetic or acquired weakness in immunity. The fungal hyphae were localized and accumulated within single sinus instead of being eradicated by host.
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Affiliation(s)
- Rong-San Jiang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Wan-Chun Huang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kai-Li Liang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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30
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Halliday L, Curragh D, Selva D. A rare case of invasive sino-orbital aspergillosis arising from isolated frontal sinus infection. Can J Ophthalmol 2018; 54:e19-e21. [PMID: 30851789 DOI: 10.1016/j.jcjo.2018.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Luke Halliday
- University of Adelaide, Adelaide, Australia; South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.
| | - David Curragh
- University of Adelaide, Adelaide, Australia; South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
| | - Dinesh Selva
- University of Adelaide, Adelaide, Australia; South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
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31
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Primary Aspergillosis of the Sphenoid Sinus Observed on Bone SPECT/CT. Clin Nucl Med 2018; 43:141-143. [PMID: 29261632 DOI: 10.1097/rlu.0000000000001957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The bone SPECT/CT allows for precise anatomic delineation of bone activity, which can be valuable for diagnosis of nonmalignant bone diseases. We report an extremely rare case of sphenoid sinus aspergillosis, observed on bone SPECT/CT imaging, as an isolated disease in an immunocompetent individual. A 58-year-old woman with a history of plantar fasciitis was assessed for infection in the tarsal bones. Planar bone scan image revealed incidental focal lesion in skull base, which was considered to be the left sphenoid sinusitis by the bone SPECT/CT scan.
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32
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Endoscopic Modified Medial Maxillectomy for Fungal Ball of the Hypoplastic Maxillary Sinus With Bony Hypertrophy. J Craniofac Surg 2018; 29:e304-e307. [DOI: 10.1097/scs.0000000000004379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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33
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Dufour X, Kauffmann-Lacroix C, Roblot F, Goujon JM, Breux JP, Ferrie JC, Michel Klossek J. Chronic Invasive Fungal Rhinosinusitis: Two New Cases and Review of the Literature. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Chronic invasive fungal rhinosinusitis is rare in the immunocompetent patient. Few cases have been published except for in a specific geographic area (Sudan, India). Methods and Results We reported two new cases of chronic invasive fungal rhinosinusitis due to Aspergillus, which was successfully treated, to analyze the different clinical, radiological, and mycological criteria. Conclusion Through these two new clinical cases and the analysis of the literature, we suggested, in the absence of general agreement on the surgical and medical management, the current strategies available for this rare pathology. New antifungal drugs seem to be an efficient alternative to classic antifungal agents, especially those that require an extended course of oral therapy for the chronic invasive form.
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Affiliation(s)
- Xavier Dufour
- Departments of Ear, Nose, and Throat and Maxillofacial Surgery France
| | | | - France Roblot
- Departments of Infectious Diseases Poitiers Cedex, France
| | | | | | - Jean Claude Ferrie
- Departments of Radiology, C. H. University Poitiers, Poitiers Cedex, France
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34
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Chao TK, Liu CM. Gauze-Assisted Technique in Endoscopic Removal of Fungus Balls of the Maxillary Sinus. ACTA ACUST UNITED AC 2018; 20:417-20. [PMID: 16955771 DOI: 10.2500/ajr.2006.20.2872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The aim of this study was to establish and evaluate a newly developed gauze-assisted technique in complete removal of fungus balls of the maxillary sinus with usual instruments of endoscopic sinus surgery. Methods Fifteen adults with fungus balls of the maxillary sinus were collected. A newly developed surgical technique that involves the replacement of the fungus balls with the gauze strip was applied. The number of course and duration of this procedure were recorded. Results The fungal material was removed with less than two courses of this procedure in these patients. The duration of this procedure ranged from 2 to 5 minutes with an average of 4 minutes. Postoperatively, these patients had been followed for 16–50 months with an average of 29 months. Neither recurrence nor complication was noted. Conclusion With the excellent results, we strongly suggest this easy and timesaving technique in the management of such patients.
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Affiliation(s)
- Ting-Kuang Chao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.
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35
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Schlosser RJ, Gross CW, Kountakis S. Skull Base Erosion by Sphenoid Fungus Balls: Diagnosis and Endoscopic Treatment. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240201600307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Fungus balls typically are innocuous lesions found in immunocompetent hosts. They are located most commonly in the maxillary sinus but may be life-threatening when found in the sphenoid sinus. Methods We review our series of four sphenoid fungus balls with skull base erosion. Results Our average patient age was 68.7 years old (56–86 years) with three women and one man. One patient was insulin-dependent diabetic, the other three patients were otherwise healthy. The most common presenting symptoms were headache and dizziness with relatively few sinus-specific complaints. Endoscopy revealed polyps in two of the four patients. Computerized tomography scans revealed thickened osteitic bone in three cases and two of the four computed tomography scans showed microcalcification. All patients had bony erosion over the internal carotid arteries. Additionally, one patient internal carotid artery thrombosis, one patient had erosion of the planum sphenoidale, and a third patient had erosion to the brainstem inferior to the sella turcica. Three patients had magnetic resonance imaging that revealed heterogeneous lesions. Two magnetic resonance images showed hypointense T1 and T2 imaging. The third was isointense on T1 and hypointense on T2. All patients were treated with endoscopic marsupialization and removal of all gross fungal debris without complications. All pathological specimens were diagnostic for fungus balls. One of four cultures was positive for fungus. All patients are asymptomatic at time of last follow-up. Conclusions Sphenoid fungus balls present with vague, non-rhinological symptoms, but may have significant local expansion and destruction. These potentially lethal lesions usually can be suspected on preoperative imaging and are best treated with endoscopic removal.
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Affiliation(s)
- Rodney J. Schlosser
- Department of Otolaryngology–Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia
| | - Charles W. Gross
- Department of Otolaryngology–Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia
| | - Stilianos Kountakis
- Department of Otolaryngology–Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia
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36
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Fungus Ball of the Maxillary Sinus Presenting With Epiphora. Ophthalmic Plast Reconstr Surg 2017; 33:S27-S29. [PMID: 26863042 DOI: 10.1097/iop.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors report a case of fungus ball of the maxillary sinus with bone erosion presenting with epiphora, which was diagnosed after treatment failure using silicone intubation for nasolacrimal duct obstruction. Symptoms of sinus fungus ball are similar to those of chronic bacterial rhinosinusitis, although occasionally asymptomatic. To our knowledge, epiphora has never been reported as a symptom of sinus fungus ball. The purpose of this report is to emphasize the importance of considering sinonasal causes when evaluating epiphora patients, as well as to suggest the use of preoperative CT scans for a more accurate diagnosis and to prevent unnecessary procedures.
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37
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Abstract
Tearing is a frequently encountered chief complaint in an ophthalmologist's office. Certain associated atypical symptoms may warrant further workup. The authors present a case of a patient presenting with painful tearing which elicited further evaluation with CT imaging. This revealed a maxillary sinus fungus ball as the cause for the patient's tearing.
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38
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Yoon YH, Xu J, Park SK, Heo JH, Kim YM, Rha KS. A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015). Int Forum Allergy Rhinol 2017; 7:1070-1075. [DOI: 10.1002/alr.22007] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/19/2017] [Accepted: 08/02/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Young Hoon Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
| | - Jun Xu
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
- Department of Otorhinolaryngology-Head and Neck Surgery; Yanbian University Hospital; Yanbian China
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
| | - Jae Hyung Heo
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
| | - Ki-Sang Rha
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
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39
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Denning DW, Chakrabarti A. Pulmonary and sinus fungal diseases in non-immunocompromised patients. THE LANCET. INFECTIOUS DISEASES 2017; 17:e357-e366. [PMID: 28774699 DOI: 10.1016/s1473-3099(17)30309-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/16/2016] [Accepted: 03/24/2017] [Indexed: 12/19/2022]
Abstract
The human respiratory tract is exposed daily to airborne fungi, fungal enzymes, and secondary metabolites. The endemic fungi Histoplasma capsulatum, Coccidioides spp, Blastomyces dermatitidis, and Paracoccidioides brasiliensis, and occasionally Aspergillus fumigatus, are primary pulmonary pathogens of otherwise healthy people. Such infections resolve in most people, and only a few infections lead to disease. However, many fungi are directly allergenic by colonising the respiratory tract or indirectly through contact with cell wall constituents and proteases, causing or exacerbating allergic disease. Increasing evidence implicates high indoor fungal exposures as a precipitant of asthma in children and in worsening asthma symptoms. Lung or airways infection by endemic fungi or aspergillus can be diagnosed with respiratory sample culture or serum IgG testing. Sputum, induced sputum, or bronchial specimens are all suitable specimens for detecting fungi; microscopy, fungal culture, galactomannan antigen, and aspergillus PCR are useful tests. Antifungal treatment is indicated in almost all patients with chronic cavitary pulmonary infections, chronic invasive and granulomatous rhinosinusitis, and aspergillus bronchitis. Most patients with fungal asthma benefit from antifungal therapy. Adverse reactions to oral azoles, drug interactions, and azole resistance in Aspergillus spp limit therapy. Environmental exposures, genetic factors, and structural pulmonary risk factors probably underlie disease but are poorly understood.
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Affiliation(s)
- David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland; The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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40
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Carniol ET, Vázquez A, Patel TD, Liu JK, Eloy JA. Utility of intraoperative flexible endoscopy in frontal sinus surgery. ALLERGY & RHINOLOGY 2017; 8:81-84. [PMID: 28583231 PMCID: PMC5468760 DOI: 10.2500/ar.2017.8.0205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Surgical management of the frontal sinus can be challenging. Extensive frontal sinus pneumatization may form a far lateral or supraorbital recess that can be difficult to reach by conventional endoscopic surgical techniques, requiring extended approaches such as the Draf III (or endoscopic modified Lothrop) procedure. Rigid endoscopes may not allow visualization of these lateral limits to ensure full evacuation of the disease process. Methods: Here we describe the utility of intraoperative flexible endoscopy in two patients with far lateral frontal sinus disease. Results: In both cases, flexible endoscopy allowed confirmation of complete evacuation of pathologic material, thereby obviating more extensive surgical dissection. Conclusion: In cases where visualization of the far lateral frontal sinus is inadequate with rigid endoscopes, flexible endoscopy can be used to determine the need for more extensive dissection.
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Affiliation(s)
- Eric T. Carniol
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Tapan D. Patel
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - James K. Liu
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, and
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- From the Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- The Sinus Institute of Rhode Island, East Providence, Rhode Island
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, and
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Abstract
Abstract
Fungus ball (FB) of the paranasal sinuses has a distinctive clinicopathological presentation. The disease occurs more frequently in elderly patients and has a female preponderance. Classically, it involves only one paranasal sinus in more than 90% of the cases, most commonly the maxillary sinus. Imaging characteristics (calcifications and / or erosion of the inner wall of the sinus visible on CT) and histopathological ones (luminal aggregation of fungal hyphae) confirm the diagnosis.
Allergic fungal rhinosinusitis (AFRS) usually occurs in younger, immunocompetent patients, with a history of atopy, including allergic rhinitis and / or asthma, or a long clinical picture of chronic rhinosinusitis (CRS), refractory to antibiotic treatment. Nasal polyps (NP) are present in almost all patients, while extra-sinusal complications are described only in some of them. Usually, there is involvement of several sinuses, as well as bilateral damage. The definitive diagnosis is confirmed only by examining surgical specimens - the characteristic appearance of eosinophilic mucin is the most reliable indicator of AFRS.
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Affiliation(s)
- Lucia Cojocari
- Department of Otorhinolaryngology, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Chisinau, 165 Stefan Cel Mare si Sfant Blvd., MD-2004, Chisinau, Moldova (Republic of)
| | - Alexandru Sandul
- Department of Otorhinolaryngology, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Chisinau, Republic of Moldova Moldova (Republic of)
- Department of Otorhinolaryngology, Republican Clinical Hospital, Chisinau, Moldova (Republic of)
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42
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Bernardini E, Karligkiotis A, Fortunato S, Castelnuovo P, Dallan I. Surgical and pathogenetic considerations of frontal sinus fungus ball. Eur Arch Otorhinolaryngol 2017; 274:2493-2497. [PMID: 28289831 DOI: 10.1007/s00405-017-4531-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/07/2017] [Indexed: 11/30/2022]
Abstract
Fungus ball (FB) is an non-invasive form of mycosis, that generally affects immunocompetent and non-atopic subjects. Involvement of the frontal sinus is extremely rare. We report two cases with frontal sinus fungus ball that underwent endoscopic endonasal frontal Draf type IIb or III sinusotomy with complete removal of the cheesy clay-like material. There were no intra-operative or postoperative complications, and no recurrence of disease was evident during the follow-up of 51 and 26 months, respectively. The Draf type IIb or type III frontal sinusotomy seems to be highly effective for the treatment of frontal sinus FB and can represent a valid alternative to the traditional external approaches.
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Affiliation(s)
- Elena Bernardini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100, Varese, Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100, Varese, Italy. .,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRC), Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | | | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRC), Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Iacopo Dallan
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRC), Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Department of Otorhinolaryngology, University of Pisa, Pisa, Italy
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43
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Michel J, Radulesco T, Mancini J, Paganelli A, Varoquaux A, Adalian P, Ranque S, Dessi P. Maxillary sinus volume: new physiopathological data in fungal ball genesis? A retrospective study. Clin Otolaryngol 2017; 42:831-836. [PMID: 28004496 DOI: 10.1111/coa.12813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The goal of this study was to compare maxillary sinus (MS) volume in patients with, or without, maxillary fungal ball. DESIGN Monocentric retrospective study performed on 115 patient CT scans. SETTINGS We defined two groups of patients according to the absence (control group) or the presence (fungal ball group) of unilateral fungal ball in the MS. Sinus 3D reconstruction was created from CT scan. PARTICIPANTS Control group: 71 patients (36 women - 50.7%); mean age was 51 years. Fungal ball group: 44 patients (29 women - 65.9%); mean age was 54.5 years. MAIN OUTCOME MEASURE The univariate association between MS volume and sinus covariates was tested by anova. Multivariate analysis was made including all variables statistically significant in univariate analysis. RESULTS In the control group, mean MS volume was 14 766 mm3 . The volumes of the two MSs were not statistically different in the control group (P = 0.145). In the fungal ball group, mean MS volume was 15 982 mm3 . Fungal ball was found in the smallest MS in 41 of 44 cases. Univariate analysis showed a statistical difference between the pathological and the non-pathological MS volumes (P < 10-4 ). Multivariate analysis confirmed the correlation between MS volume and the presence of a fungal ball (P < 10-4 ). CONCLUSIONS This study suggests that maxillary fungal ball is associated with a smaller size of the affected MS.
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Affiliation(s)
- J Michel
- Department of Otorhinolaryngology, Head and Neck Surgery, APHM CHU La Conception, Marseille, France.,UMR 7268 ADES - Aix-Marseille University/EFS/CNRS, Marseille, France
| | - T Radulesco
- Department of Otorhinolaryngology, Head and Neck Surgery, APHM CHU La Conception, Marseille, France.,UMR 7268 ADES - Aix-Marseille University/EFS/CNRS, Marseille, France
| | - J Mancini
- Department of Public Health and Medical Information, APHM CHU La Timone and Aix-Marseille University, Marseille, France
| | - A Paganelli
- Department of Otorhinolaryngology, Head and Neck Surgery, APHM CHU La Conception, Marseille, France.,UMR 7268 ADES - Aix-Marseille University/EFS/CNRS, Marseille, France
| | - A Varoquaux
- Department of Radiology, APHM CHU La Timone, Marseille, France
| | - P Adalian
- UMR 7268 ADES - Aix-Marseille University/EFS/CNRS, Marseille, France
| | - S Ranque
- Parasitologie-Mycologie, APHM CHU La Timone and Aix-Marseille University, Marseille, France.,IP-TPT UMR MD3, Aix-Marseille University, Marseilles, France
| | - P Dessi
- Department of Otorhinolaryngology, Head and Neck Surgery, APHM CHU La Conception, Marseille, France.,UMR 7268 ADES - Aix-Marseille University/EFS/CNRS, Marseille, France
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44
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Analysis of sinonasal anatomical variations associated with maxillary sinus fungal balls. Auris Nasus Larynx 2016; 43:524-8. [DOI: 10.1016/j.anl.2015.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/11/2015] [Accepted: 12/23/2015] [Indexed: 11/20/2022]
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45
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46
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Dufour X, Kauffmann-Lacroix C, Goujon JM, Grollier G, Rodier MH, Klossek JM. Experimental Model of Fungal Sinusitis: A Pilot Study in Rabbits. Ann Otol Rhinol Laryngol 2016; 114:167-72. [PMID: 15757199 DOI: 10.1177/000348940511400215] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have established an experimental model of fungal sinusitis in rabbits to analyze the chronology and the pathogenesis of the development of noninvasive fungal sinusitis due to Aspergillus fumigatus. Thirty-four Pasteurella-free New Zealand white rabbits divided into three groups were included in this study. In the first group (10 rabbits), A fumigatus was inoculated into the maxillary sinus. In the second group (10 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a wound in the mucosa. In the third group (14 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a blocked ostium. On days 15 and 30, endoscopic, histopathologic, bacterial, and mycological examinations of both maxillary cavities and mucous membrane were performed. The rabbits were painlessly sacrificed 30 days after inoculation; mucosal and bone biopsies of the maxillary sinus cavities were performed for histopathologic studies. We found that noninvasive fungal sinusitis had been induced in 2 rabbits of the second group and 8 rabbits of the third group. We conclude that introduction of fungi into a sinus with a blocked ostium induces fungal sinusitis. The present model of experimental fungal sinusitis seems to be reproducible and suitable for further studies of the development of fungal sinusitis.
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Affiliation(s)
- Xavier Dufour
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center of Poitiers, Poitiers, France
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Kim JS, Kim BK, Hong SD, Kim HJ, Kim HY. Clinical Characteristics of Sphenoid Sinus Fungal Ball Patients With Visual Disturbance. Clin Exp Otorhinolaryngol 2016; 9:326-331. [PMID: 27136367 PMCID: PMC5115146 DOI: 10.21053/ceo.2015.01571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives A 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. Methods We 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. Results Old 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. Conclusion It 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.
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Affiliation(s)
- Jong Sei Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Kil Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hyperprolactinemia Secondary to Allergic Fungal Sinusitis Compressing the Pituitary Gland. Case Rep Otolaryngol 2016; 2016:7260707. [PMID: 26998375 PMCID: PMC4779514 DOI: 10.1155/2016/7260707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/22/2016] [Accepted: 02/04/2016] [Indexed: 11/18/2022] Open
Abstract
Objective. We aim to describe the first case in the literature of allergic fungal sinusitis (AFS) presenting with hyperprolactinemia due to compression of the pituitary gland. Case Presentation. A 37-year-old female presented with bilateral galactorrhea and occipital headaches of several weeks. Workup revealed elevated prolactin of 94.4, negative pregnancy test, and normal thyroid function. MRI and CT demonstrated a 5.0 × 2.7 × 2.5 cm heterogeneous expansile mass in the right sphenoid sinus with no pituitary adenoma as originally suspected. Patient was placed on cabergoline for symptomatic control until definitive treatment. Results. The patient underwent right endoscopic sphenoidotomy, which revealed nasal polyps and fungal debris in the sphenoid sinus, consistent with AFS. There was bony erosion of the sella and clivus. Pathology and microbiology were consistent with allergic fungal sinusitis caused by Curvularia species. Prolactin levels normalized four weeks after surgery with resolution of symptoms. Conclusion. Functional endoscopic sinus surgery alone was able to reverse the patient's pituitary dysfunction. To our knowledge, this is the first case of AFS presenting as hyperprolactinemia due to pituitary compression.
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Lop-Gros J, Gras-Cabrerizo JR, Bothe-González C, Montserrat-Gili JR, Sumarroca-Trouboul A, Massegur-Solench H. Fungus ball of the paranasal sinuses: Analysis of our serie of patients. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 67:220-5. [PMID: 26708329 DOI: 10.1016/j.otorri.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The fungus ball is the most frequent type of fungal rhino-sinusitis. The objective of this study is to analyze the clinical and surgical features of our patients. METHODS Retrospective analysis of 35 patients with fungus ball treated in our centre between 2006 and 2014. RESULTS Mean age was 55 years old. 49% were men and 51% women. 75% involved the maxillary sinus, whereas 25% involved the sphenoid. 69% of our patients showed microcalcifications in the CT study. All the patients were surgically treated, with no cases of recurrence. CONCLUSIONS Clinical manifestations of fungus ball are non-specific, therefore endoscopy and image study are mandatory. The definitive diagnosis is made by histopathological study of the lesion. Endoscopic sinus surgery is the treatment of choice, with opening of the diseased sinus and complete removal of the fungus ball. The frequency of complications is very low. No oral or topical antimycotic treatments are necessary.
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Affiliation(s)
- Joan Lop-Gros
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España.
| | - Juan R Gras-Cabrerizo
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Carolina Bothe-González
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Juan R Montserrat-Gili
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Anna Sumarroca-Trouboul
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
| | - Humbert Massegur-Solench
- Sección de Rinología, Servicio de Otorrinolaringología, Hospital de la Santa Creu i de Sant Pau , Barcelona , España
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Abstract
Fungus ball in the concha bullosa is an extremely rare disease. We described a case of the fungus ball in the concha bullosa in a 22-year-old woman. Preoperative diagnosis was based on nasal endoscopy and computed tomography scanning. The patient was endoscopically operated on. The examination of the removed material was reported as fungal infection. This case was found worth writing because of the location of the concha bullosa and its rare occurrence in this location.
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