In the past, fungal infections of the sinuses have been blamed for causing most cases of chronic rhinosinusitis.[1] This is because fungal elements are ubiquitous and can often be found in the nose and paranasal sinuses. However, in most situations, the presence of fungi in the sinuses is not related to sinusitis. The role of fungal antigens in the development of chronic rhinosinusitis has yet to be determined.[2, 3, 4]
Fungal sinus infections can be either noninvasive (benign) or invasive. Although invasive fungal sinusitis occurs in individuals who are immunocompromised, there have been several reports of invasive fungal infections in immunocompetent individuals.[5, 6, 7, 8]
Distinguishing invasive disease from noninvasive disease is important because the treatment and prognosis are different for each. Noninvasive disease has two varieties of presentations (fungal ball and allergic fungal rhinosinusitis), and invasive disease has three varieties of presentations (acute invasive, chronic invasive, and granulomatous invasive fungal sinusitis). This article reviews all five varieties.
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Axial CT scan of sinuses shows a right fungal maxillary sinusitis with an expanding mass (possibly aspergillosis).
A literature review by Dacey et al indicated that the characteristics of patients with invasive fungal sinusitis differ between children and adults, with hematologic malignancies being more prevalent in children than adults (59.1% vs 15.2%, respectively). While children less often presented with extension of the infection beyond the sinuses, they more often presented with fever and nasal or oral mucosal lesions. The mortality rate did not significantly differ between children and adults.[9]
Workup in fungal sinusitis
Elevated serum fungus-specific immunoglobulin E (IgE) concentrations are often found in patients with allergic fungal rhinosinusitis. This is less common in patients with sinus mycetoma.
Computed tomography (CT) scanning of the paranasal sinuses in the coronal view is essential for the evaluation of patients in whom fungal sinusitis is suspected.[10, 11] Magnetic resonance imaging (MRI) with enhancement is often helpful in assessing patients with allergic fungal rhinosinusitis and in patients in whom invasive fungal rhinosinusitis is suspected.[11]
Management of fungal sinusitis
The treatment of choice for all types of fungal sinusitis is surgical, with patients commonly undergoing débridement to clear the burden of fungal elements. Medical treatment depends on the type of infection and the presence of invasion. In allergic fungal rhinosinusitis, for example, systemic steroids and allergy treatment may be indicated once surgery is performed and the diagnosis is confirmed. In invasive fungal sinusitis, medical treatment with systemic antifungal therapy is initiated once invasion is diagnosed.
Fungal infections of the paranasal sinuses are uncommon. The status of the patient’s immune system determines the type of fungal sinusitis that occurs. Invasive fungal sinusitis usually arises in individuals who are immunocompromised, although its occurrence has increased in the immunocompetent population.
The most common pathogens are Aspergillus and Mucor species. Aspergillus species can cause noninvasive or invasive infections, whereas Mucor species typically cause severe invasive infections. Invasive infections, which are characterized by dark, thick, greasy material found in the sinuses, can cause tissue invasion and destruction of adjacent structures (eg, orbit, central nervous system [CNS]). Noninvasive infections cause symptoms of sinusitis and often lead to nasal polyposis.
In noninvasive fungal sinusitis, the involved sinuses are opacified on radiographic studies, and routine cultures from the sinuses rarely demonstrate the fungus. However, the fungus is usually suspected upon reviewing the computed tomography (CT) scan result and is detected on removal of secretions from the sinus.
Fungal infections of the paranasal sinus can manifest as two distinct entities.
The more serious infection commonly occurs in patients with diabetes mellitus or in individuals who are immunocompromised. It is characterized by its invasiveness, tissue destruction, and rapid onset. Early detection and treatment are vital for these infections because of their associated high mortality rate.
A noninvasive infection is chronic and is usually treated for an extended period of time as chronic rhinosinusitis before the condition is recognized.
Two forms are described in this category, allergic fungal rhinosinusitis (AFRS) and sinus fungal ball. Most commonly, Curvularia lunata,Aspergillus fumigatus, and Bipolaris and Drechslera species cause allergic fungal rhinosinusitis.
A fumigatus and dematiaceous fungi most commonly cause sinus fungal balls.
Allergic fungal rhinosinusitis occurs more commonly in African Americans and in individuals with low socioeconomic status. A study by Lu-Myers et al found that socioeconomic and demographic factors differed between patients with allergic fungal rhinosinusitis and those with chronic rhinosinusitis. Patients with chronic rhinosinusitis were more commonly White and older, with a higher income and greater access to primary care. The study, which involved a total of 186 patients (93 patients in each group), also found that patients with allergic fungal rhinosinusitis tended to have higher markers of disease severity, including greater quantitative serum IgE levels and higher Lund-Mackay CT-scan scores, than did patients with chronic rhinosinusitis.[12]
Invasive fungal sinusitis
Invasive fungal sinusitis includes the acute fulminant type, which has a high mortality rate if not recognized early and treated aggressively, and the chronic and granulomatous types.
Saprophytic fungi of the order Mucorales, including Rhizopus,Rhizomucor,Absidia,Mucor,Cunninghamella,Mortierella,Saksenaea, and Apophysomyces species, cause acute invasive fungal sinusitis.
A fumigatus is the fungus that is most commonly associated with chronic invasive fungal sinusitis.
Aspergillus flavus is the fungus most commonly associated with granulomatous invasive fungal sinusitis.
A study by Kim et al suggested that an association exists between periodontitis and the development of invasive fungal sinusitis. Comparing a group of individuals with periodontitis to one without (with each group numbering over 12,000 persons), the investigators reported that the adjusted hazard ratio (HR) for invasive fungal sinusitis in the group with periodontitis was 2.80. The risk for sinus fungal balls was also higher in the group with periodontitis, the adjusted HR being 1.46.[13]
Allergic rhinitis is prevalent in people with, and is considered to be the trigger mechanism for, allergic fungal rhinosinusitis. Patients are immunocompetent and often have asthma, eosinophilia, and elevated serum fungus-specific IgE concentrations.[14]
Surgery reveals greenish black or brown material (ie, eosinophilic mucin), which has the consistency of peanut butter mixed with sand and glue. Eosinophilic mucin and polyps may form a partially calcified expansile mass that obstructs sinus drainage. Growth of the mass may cause pressure-induced erosion of sinus bone, rupture of sinus walls, and pressure to adjacent structures such as the orbit and brain, with occasional leakage of the sinus contents into the surroundings.
A study by Gupta et al indicated that allergic fungal rhinosinusitis tends to be more severe when granulomas are present. The study involved 57 patients with allergic fungal rhinosinusitis, including nine patients with granulomas, with the investigators finding that those with granulomas had a tendency toward orbital and skull base erosion, as well as telecanthus, diplopia, exophthalmos, and facial pain.[15]
Sinus fungal ball (mycetoma)
This condition is usually unilateral and most commonly involves the maxillary sinus, followed by the sphenoid sinus. Mucopurulent, cheesy, or claylike material is present at the time of surgery. Patients with sinus fungal ball are typically immunocompetent. Allergic conditions and fungus-specific IgE are less common.
Acute invasive fungal sinusitis
Acute invasive fungal sinusitis, also called fulminant invasive fungal sinusitis, results from a rapid spread of fungi through vascular invasion of sinus tissue, the orbit, and the CNS. It is common in patients with insulin-dependent diabetes mellitus and in persons who are immunocompromised. In rare cases, it has been reported in immunocompetent individuals. Typically, patients with acute invasive fungal sinusitis are severely ill with fever, cough, nasal discharge, headache, cranial neuropathies, and mental status changes. They usually require hospitalization.
Chronic invasive fungal sinusitis
Chronic invasive fungal sinusitis is a slowly progressive fungal infection with a low-grade invasive process. It occurs most commonly in patients with diabetes mellitus.
Non-specific rhinosinusitis symptoms that slowly progress are common. Orbital apex syndrome, which is characterized by a decrease in visual acuity and ocular immobility due involvement of the superior portion of the orbit, is usually associated with this condition and is an indicator of the disease's progression.
Granulomatous invasive fungal sinusitis
This condition has been reported almost exclusively in immunocompetent individuals from North Africa. Generally, proptosis is associated with granulomatous invasive fungal sinusitis.
Preinvasive fungal sinusitis
A study by Paknezhad et al indicated that in addition to the invasive and noninvasive forms of fungal sinusitis, an intermediate, or preinvasive, subtype exists. In this form, intramucosal fungal infiltration occurs, but neither direct angioinvasion nor wide extension beyond the submucosa is found. The investigators reported that patients with preinvasive fungal sinusitis appear to need only limited surgical débridement, rather than the extended and repeated débridement required in invasive fungal sinusitis.[16]
Patients present with symptoms of chronic rhinosinusitis, which may include facial pressure, headache, nasal stuffiness, discharge, and cough. The condition should be suspected in individuals with intractable sinusitis and nasal polyposis.
Facial dysmorphia such as malar flattening, proptosis, or telecanthus is common, having resulted from the expansile effect of the disease on adjacent structures. Patients with allergic fungal sinusitis usually have atopy and have had multiple surgeries by the time of diagnosis. CT scanning of the sinuses reveals opacification with concretions and/or calcifications.
Sinus fungal ball (mycetoma)
The presentation of sinus fungal ball shares similarities with that of chronic rhinosinusitis. Cheek pressure and nasal congestion are common in patients with maxillary sinus fungal ball. Chronic headache is common in patients with sphenoid sinus fungal ball. Examination may reveal polyposis with evidence of sinusitis, mainly on one side. The main sign reported is a blowing of gravel-like material from the nose. Usually, sinus fungal ball is found accidentally on CT sinus scans.
Acute invasive fungal sinusitis
Patients are usually hospitalized and are very sick with fever, cough, nasal discharge, headache, and mental status changes. A high index of suspicion for early diagnosis is critical, especially in individuals who are immunocompromised. Acute invasive fungal sinusitis carries a mortality rate of up to 50%.[17]
Signs and symptoms include dark eschars on the septum, inferior and middle turbinates, and/or palate. In the late stages, signs and symptoms of cavernous sinus thrombosis and cranial neuropathies are present.
Chronic invasive fungal sinusitis
Patients present with symptoms of long-standing rhinosinusitis. Symptoms are usually not acute, and fever and mental status changes are absent.
Orbital apex syndrome, which is characterized by a decrease in visual acuity and by ocular immobility, due involvement of the superior portion of the orbit, is usually associated with this condition.
Nasal examination findings can be minimal. However, findings from the eye examination can be positive.
Granulomatous invasive fungal sinusitis
Patients present with symptoms of chronic rhinosinusitis associated with proptosis. Examination of the nasal cavity can be nonrevealing. However, findings from the eye examination are usually impressive.
All forms of fungal sinusitis require surgical treatment. The only contraindications to surgical management relate to the general condition of the patient. Before surgery is recommended, risks and benefits of the surgical procedure should be weighed against the risks of general anesthesia.
Laboratory studies are of limited value in fungal sinusitis. Elevated serum fungus-specific IgE concentrations are often found in patients with allergic fungal rhinosinusitis, as this disease is mediated through an IgE type I hypersensitivity immune reaction to the fungal elements. This is not the case in patients with sinus fungal ball who have normal serum IgE levels.
Using enzyme-linked immunosorbent assays, one study examined the sinonasal tissue and secretions in patients with chronic rhinosinusitis for the presence of mycotoxins (ie, aflatoxin, deoxynivalenol, zearalenone, ochratoxin, fumonisin) to determine their possible role, if any, in chronic rhinosinusitis. No mycotoxins were found, except ochratoxin in four of 18 samples. The clinical significance of these results has not been determined.[18]
In patients with acute invasive fungal sinusitis, measurements of the immune status (eg, absolute neutrophil count, blood glucose level) are important. A study by Payne et al of 41 patients with acute invasive fungal rhinosinusitis reported that predictive variables for the disease include an absolute neutrophil count below 500/μL (sensitivity of 78%), abnormalities of the septal mucosa (specificity of 97%), and necrosis and mucosal abnormalities of the middle turbinate (specificities of 97% and 88%, respectively).[19]
Serum galactomannan Aspergillus antigen is under investigation as a screening test for invasive fungal sinusitis. A study by Melancon et al showed that this test is highly specific (100%), with high positive predictive value (100%).[20] However, its sensitivity is low (44.8%), likely because it only detects cases caused by Aspergillus species.
CT scanning of the paranasal sinuses in coronal views is essential to the evaluation of patients suspected of having fungal sinusitis.[10, 11]
In acute invasive fungal sinusitis, CT scan characteristics include mucosal thickening, soft tissue and fat infiltration, bone erosion, and involvement of the orbit, pterygopalatine fossa, and CNS.
Middlebrooks et al devised a seven-variable, CT scan–based diagnostic model for patients at risk of acute invasive fungal rhinosinusitis. They reported that an abnormality associated with one of the model’s variables—which consist of periantral fat infiltration, bone dehiscence, orbital invasion, septal ulceration, and involvement of the pterygopalatine fossa, nasolacrimal duct, and lacrimal sac—has a positive predictive value of 87%, a negative predictive value of 95%, a sensitivity of 95%, and a specificity of 86%; the involvement of two variables gives the model a specificity of 100% and a positive predictive value of 100%.[21]
MRI is useful in evaluating orbital and intracranial involvement in acute invasive fungal sinusitis.
In patients with sinus fungal ball, CT scanning shows unilateral sinus opacification with dense hyperattenuations. These hyperdensities or calcifications result from a dense collection of hyphae inside the sinus. A retrospective study by Cha et al indicated that other CT scan characteristics can be used to help identify sinus fungal balls. Those include a “sinus fuzzy appearance and sinus full haziness with mass effect.”[22] MRI is rarely necessary in the workup of sinus fungal balls, but when obtained, fungal balls can be suggested by the presence of an isointense signal within the fungal mass on T1, in conjunction with dark-signal lesions surrounded by high-signal enhancement of the mucosal walls on T2.[23]
In allergic fungal rhinosinusitis, both CT scanning and MRI are helpful in making an accurate diagnosis. Allergic fungal rhinosinusitis can occur unilaterally in up to 20% of patients but typically involves multiple sinuses. CT scan characteristics include fully opacified and expanded sinuses, bony demineralization and erosion, displacement of adjacent structures (eg, orbit, skull base), and hyperdensities within the sinuses. MRI may show hypointensity within the sinus (dense fungal elements), with enhancement of the sinus periphery (mucosal inflammation) on T1 and T2 signals.
In allergic fungal rhinosinusitis, eosinophilic mucin contains intact and degenerated eosinophils, Charcot-Leyden crystals, cellular debris, and sparse hyphae. The sinus mucosa has mixed cellular infiltrate of eosinophils, plasma cells, and lymphocytes. The mucus membrane is not invaded by fungi.
No eosinophilic mucin is present in sinus fungal ball. However, the sinus contains dense material that consists of hyphae separate from but adjacent to the mucosa. The sinus mucosa is not invaded.
Histopathologic studies in acute invasive fungal sinusitis reveal hyphal invasion of the mucosa, submucosa, nerves, and blood vessels, including the carotid arteries and cavernous sinuses; vasculitis with thrombosis; hemorrhage; and tissue infarction.
Necrosis of the mucosa, submucosa, and blood vessels, with low-grade inflammation, is observed in chronic invasive fungal sinusitis.
Granuloma with multinucleated giant cells with pressure necrosis and erosion is observed in granulomatous invasive fungal sinusitis.
A retrospective study by Melancon and Clinger indicated that in the diagnosis of acute invasive fungal sinusitis, frozen section biopsies have a positive predictive value of 100%, a sensitivity of 87.5%, and a specificity of 100% and are therefore important in the early diagnosis of this disease.[24]
The treatment of choice for all types of fungal sinusitis is surgical. Medical therapy serves mainly as postoperative adjuvant treatment and depends on the type of infection and whether invasion has occurred.
Allergic fungal rhinosinusitis
The treatment of choice is generally endoscopic sinus surgery. Systemic steroids have a role pre-operatively and postoperatively. Some surgeons advocate the use of pre-operative high-dose oral prednisone (0.5-1 mg/kg/day, up to 60 mg/day) to improve blood loss during surgery. Most surgeons, however, use oral prednisone postoperatively in a tapering dose over a 1- to 3-month period, once surgery is performed and the diagnosis is confirmed.
Aggressive nasal salt-water irrigations and a topical nasal steroid (fluticasone or budesonide) are essential postoperatively to prevent recurrence. Immunotherapy for specific allergens is controversial; it is a safe adjunct therapy with unclear benefits, even though some reports suggest benefit from this treatment.[25, 26] Systemic antifungals are not indicated in the absence of invasion.
Biologic therapy (antibody-based therapy) holds promise in the treatment of allergic fungal rhinosinusitis. Dupilumab (anti–interleukin-4 [IL-4]/IL13) has been approved by the US Food and Drug Administration (FDA) for use in chronic rhinosinusitis with nasal polyps. Its effect in patients with allergic fungal rhinosinusitis has yet to be determined.
Sinus fungal ball (mycetoma)
The recommended treatment is surgical. Once the fungal ball is removed, no further medical treatment is indicated, except for the underlying condition. No antifungal treatment is necessary.
Acute invasive fungal sinusitis
Emergent treatment is necessary once this condition is suspected. Initiate systemic antifungal treatment after surgical débridement. This is usually guided by infectious-disease specialists. High doses of liposomal amphotericin B (3-6 mg/kg/day) are recommended, especially when Mucor species are found. Voriconazole and isavuconazole are alternative agents that can be considered in milder forms caused by Aspergillus species. Oral isavuconazole is the main long-term maintenance treatment after the acute infection is under control. Treatment and reversal of the underlying immune deficiency and aggressive control of blood glucose levels, if possible, are paramount to improving the prognosis.
Chronic invasive fungal sinusitis
Surgical treatment is mandatory. Initiate medical treatment with systemic antifungals once invasion is diagnosed. Liposomal Amphotericin B (3-6 mg/kg/day) is recommended; this can be replaced by ketoconazole, Isavuconazole, or itraconazole once the disease is under control.
A study by Mehta et al suggested that itraconazole may be as effective as amphotericin B in the treatment of chronic invasive fungal sinusitis. In a prospective, randomized, unblinded study of 26 immunocompetent patients, one group (10 patients) was treated with amphotericin B and the other (16 patients) with itraconazole. A complete cure was achieved in two patients in the amphotericin-B group and five in the itraconazole group, while four amphotericin-B patients and seven itraconazole patients experienced persistent disease, and one amphotericin-B patient and three itraconazole patients had relapses. In addition, three patients died, and one was lost to follow-up. Based on relative risk analysis, the investigators concluded that itraconazole and amphotericin B worked equally well against chronic invasive fungal sinusitis.[27]
Chronic granulomatous fungal sinusitis
Surgical débridement is the mainstay of treatment, followed by systemic antifungal medications. Recurrence of this condition is rare.
Endoscopic sinus surgery is generally considered the treatment of choice. Goals of surgical therapy are complete débridement of the eosinophilic mucin, polyps (if present), and fungal debris, from the involved sinuses. This leads to restoration of sinus aeration. Leaving residual fungal and eosinophilic debris can lead to rapid and early recurrence. An external approach can be combined with the endoscopic approach if the lesion is not accessible endoscopically. Adequate ventilation of the sinus is essential to prevent relapse or recurrence of allergic fungal rhinosinusitis once the disease has been exenterated.
A retrospective study by Masterson et al found that in terms of treatment with surgical (endoscopic sinus surgery) and targeted medical intervention, quality-of-life benefits were more prolonged in patients with allergic fungal rhinosinusitis than in those with chronic rhinosinusitis without nasal polyposis (CRSsNP) at 9- and 12-month follow-up (over a 12-month follow-up period). The study, which included 154 patients with chronic rhinosinusitis with nasal polyposis, 72 patients with CRSsNP, and 24 patients with allergic fungal rhinosinusitis, measured quality of life using the 22-item Sino-nasal Outcome Test (SNOT-22).[28]
Sinus fungal ball (mycetoma)
Surgical removal of the fungal ball with aeration of the sinus is the only requirement. Once this is accomplished, no further medical treatment is indicated, except for the underlying condition. Endoscopic lesion removal can be performed when the lesion is accessible. Consider an external approach in patients in whom the mycetoma cannot be removed endoscopically.
Acute invasive fungal sinusitis
Perform emergency surgery once this condition is suspected.[29] Radical débridement of the necrotic tissue should be carried out until normal tissue is reached. Often, débridement is achieved via external approaches when the disease has progressed to adjacent structures. In some cases, neurosurgeons and/or oculoplastic surgeons should be involved.
Chronic invasive fungal sinusitis
This condition is usually less aggressive than the acute stage. Surgical débridement is still warranted and can be approached endoscopically in most patients. Consider an external approach when adequate débridement cannot be achieved endoscopically.
Chronic granulomatous fungal sinusitis
Surgical débridement is the treatment of choice. Endoscopic and external approaches can be considered.
Long-term follow-up care is required for maintenance of the sinus cavities; this may be achieved via endoscopic examination and débridement in the office. A short course of systemic steroids may be readministered if any signs of relapse or recurrence are seen. (Disease recurrence is common.) Surgical débridement may be necessary if systemic steroids fail to control the disorder. A meta-analysis found a 28.7% revision rate for surgery in allergic fungal rhinosinusitis.[30]
Sinus fungal ball (mycetoma)
Long-term follow-up care is not required once the lesions are healed and patency of the sinuses is maintained.
Acute invasive fungal sinusitis
This condition is rare and is usually associated with a high mortality rate. Survivors may have facial deformities and require long-term follow-up care by several specialists, including head and neck surgeons, infectious-disease specialists, and immunodeficiency specialists. Endoscopic surveillance is important to detect early recurrence.
Chronic invasive fungal sinusitis
This condition tends to recur. Therefore, long-term follow-up care is recommended.
Chronic granulomatous fungal sinusitis
Experience with this condition is limited. Prognosis is good, but a tendency toward recurrence exists.
Erosion and expansion of bony walls of adjacent structures may occur if the condition is left untreated, and orbital and intracranial complications can consequently result. Erosion is most often observed in individuals who present with proptosis and facial dysmorphia. Despite significant skull base compression, dural invasion and cerebrospinal fluid (CSF) leakage rarely occur.
Sinus fungal ball (mycetoma)
Fungal balls, if left untreated, cause worsening of sinusitis symptoms, with the potential for complicated sinusitis. This may predispose the patient to complications, such as those involving the orbit and CNS.
Acute invasive fungal sinusitis
Initiate emergency treatment once this condition is suspected. This is a rapidly progressive disease that invades adjacent structures, causing tissue damage and necrosis. Cavernous sinus thrombosis and invasion of the CNS are common and carry a mortality rate of 50-80%.[17]
Increased risk of developing mucormycosis (Mucorales infection) has been associated with coronavirus disease 2019 (COVID-19). This is owing to various factors, including lung scarring from COVID-19 and the use of steroids (which have an immunosuppressant effect) to treat COVID-19. A proliferation of mucormycosis cases in India as a result of the COVID-19 pandemic may be attributable to such elements as a large population with diabetes (because diabetes is a risk factor for mucormycosis) and the heavy use of steroids to manage COVID-19. As reported in literature published between December 2019 and the beginning of April 2021, about 71% of cases of mucormycosis found in COVID-19 patients around the world came from India.[31, 32, 33]
Chronic invasive fungal sinusitis
Invasion into adjacent structures is not as common as in the acute type. However, erosion into the orbit or CNS is likely if the disease is left untreated.
Chronic granulomatous fungal sinusitis
Erosion into the adjacent structures (eg, orbit, CNS) is likely. Initiate aggressive therapy to avoid erosion.
This disorder carries a good prognosis following adequate surgical débridement and aeration of the sinuses. Close follow-up care is important. Long-term use of topical steroids controls relapses. Short-term systemic steroids may be required when relapses occur.
Sinus fungal ball (mycetoma)
This condition has an excellent prognosis once the fungal ball is removed and adequate aeration of the sinus is restored. No long-term follow-up care is required for most patients.
Acute invasive fungal sinusitis
This condition carries a poor prognosis. Mortality rate is reported at 50%, even with aggressive surgical and medical treatment. Relapses are common during subsequent episodes of neutropenia. Treatment with systemic antifungals as prophylaxis is indicated in cases of neutropenia.
A retrospective study by Green et al of 14 immunocompromised pediatric patients with invasive fungal sinusitis indicated that while absolute neutrophil count was a significant prognostic factor in these children, patient age and gender, cause of immunodeficiency, and fungal agent were not.[34]
A literature review by Smith et al suggested presentation with facial pain to be a negative predictor of overall mortality (odds ratio = 0.296) in pediatric patients with invasive fungal sinusitis.[35]
Chronic invasive fungal sinusitis
Good prognosis has been noted in patients who receive a prolonged course of systemic antifungals. Patients who receive shorter courses of systemic antifungals have more relapses, thereby requiring further treatment.
Chronic granulomatous fungal sinusitis
Experience with this condition is limited. Generally, prognosis is good, but a tendency toward recurrence exists.
What is fungal sinusitis?What are the most common etiologic pathogens of fungal sinusitis?What are the types of fungal sinusitis?What is noninvasive fungal sinusitis?What is invasive fungal sinusitis?What is the pathophysiology of allergic fungal sinusitis?What is sinus mycetoma?What is acute invasive fungal sinusitis?What is chronic invasive fungal sinusitis?What is granulomatous invasive fungal sinusitis?What is preinvasive fungal sinusitis?What are the symptoms of allergic fungal sinusitis display?What are symptoms of sinus mycetoma?What symptoms does acute invasive fungal sinusitis display?What are symptoms of chronic invasive fungal sinusitis?What are symptoms of granulomatous invasive fungal sinusitis?What is the treatment of choice for fungal sinusitis?What is the relevant anatomy of fungal sinusitis?What are contraindications for the surgical management of fungal sinusitis?What is the role of lab studies in the diagnosis of fungal sinusitis?What is the role of imaging studies in the diagnosis of fungal sinusitis?Which histologic findings are characteristic of fungal sinusitis?How is allergic fungal sinusitis treated?How is sinus mycetoma treated?How is chronic invasive fungal sinusitis treated?How is acute invasive fungal sinusitis treated?How is chronic granulomatous fungal sinusitis treated?How is allergic fungal sinusitis treated surgically?How is sinus mycetoma treated surgically?How is acute invasive fungal sinusitis treated surgically?How is chronic invasive fungal sinusitis treated surgically?How is chronic granulomatous fungal sinusitis treated surgically?What is included in follow up care for allergic fungal sinusitis?What is included in follow up care for sinus mycetoma?What is included in follow up care for acute invasive fungal sinusitis?Why is follow-up care needed for chronic invasive fungal sinusitis?Why is follow-up care needed for chronic granulomatous fungal sinusitis?What are complications of allergic fungal sinusitis?What are complications of sinus mycetoma?What are complications of acute invasive fungal sinusitis?What are complications of chronic invasive fungal sinusitis?What are complications of chronic granulomatous fungal sinusitis?What is the prognosis of allergic fungal sinusitis?What is the prognosis of sinus mycetoma?What is the prognosis of acute invasive fungal sinusitis?What is the prognosis of chronic invasive fungal sinusitis?What is the prognosis of chronic granulomatous fungal sinusitis?
Hassan H Ramadan, MD, MSc, FACS, FARS, Stephen and Patricia Wetmore Professor and Chairman, Director, Sinus and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine
Disclosure: Nothing to disclose.
Coauthor(s)
Chadi A Makary, MD, Clinical Instructor, Fellow in Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University
Disclosure: Nothing to disclose.
Specialty Editors
Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Disclosure: Nothing to disclose.
Chief Editor
Arlen D Meyers, MD, MBA, Emeritus Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Neosoma; MI10;Invitrocaptal,Medtechsyndicates<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX);MI10;Invitrocaptal;MTS<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10 advisor.
Additional Contributors
Lanny Garth Close, MD, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons
Winny A. COVID-19 and Fungi: A Nightmare in the Making. Johns Hopkins Bloomberg School of Public Health. Available at https://publichealth.jhu.edu/2021/covid-19-and-fungi-a-nightmare-in-the-making. July 1, 2021; Accessed: October 20, 2022.
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