Objectives/Hypothesis Maxillary sinus fungus ball (MSFB) is the most common type of noninvasive fungal rhinosinusitis. Surgical removal of the ball achieves good outcomes. Making a rapid and accurate diagnosis is important to avoid unnecessary medical therapy. Intralesional hyperdensity (IH) on computed tomography (CT) is reportedly a good indicator. The aim of this study was to evaluate the diagnostic features of MSFB without IH on preoperative CT images. Study Design Retrospective database review. Methods Two hundred fifty‐eight patients with histopathological evidence of a sinus fungal ball were retrospectively investigated. Forty‐seven of 222 patients with MSFB did not show IH on preoperative CT images and were enrolled in the MSFB group. Forty‐one patients with unilateral nonfungal chronic rhinosinusitis were enrolled in a control group. CT features previously reported to have diagnostic significance were evaluated. Results Sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and irregular surface of the material were significantly more common in the MSFB group than in the control group. In the subgroup of patients with total opacification in the maxillary sinus, the sensitivity, specificity, and positive and negative predictive values for erosion of the inner sinus wall were more than 90%. In the subgroup with partial opacification, the sensitivity, specificity, and positive predictive value of an irregular surface of the material were more than 80%. Conclusions We have devised an algorithm to help diagnose MSFB without IH on preoperative CT images. Use of this algorithm would improve the diagnostic accuracy and ensure appropriate treatment. Level of Evidence 4 Laryngoscope, 129:1041–1045, 2019

Objectives: Maxillary sinus fungal balls (MSFBs) mostly occur in older individuals and demonstrate female predominance. Early diagnosis is important to avoid treatment delays. This study aimed to elucidate the differences in clinical and imaging presentation of MSFB with and without intralesional hyperdensity (IH). Design and setting: This was a retrospective review in a tertiary medical center. We retrospectively identified 588 patients underwent endoscopic sinus surgery procedures for MSFB between 2005 and 2018. The clinical characteristics and computed tomography (CT) findings including the presence of complete or partial opacification, IH, and odontogenic pathology were reviewed. Participants: 588 MSFB patients Results: Patients with unilateral MSFB had a mean age of 57.4 years and demonstrated female predominance (64.63%). The overall female-to-male ratio was highest at 51-60 years (2.02) and rose to 2.60 in MSFB with IH only. Compared to those with IH, MSFB without IH was significantly more common in males (OR = 2.496; P < .0001), in those with diabetes mellitus (DM) (OR = 2.094; P = .010) and adjacent maxillary odontogenic pathology (OR = 1.697; P = .030). Complete opacification on CT was less common in MSFB without IH (OR = 0.617; P = .025). Conclusion: The highest female-to-male ratio for MSFB at 51-60 years corresponded to the age of menopause. Patients with MSFB without IH were more likely to have DM, no female predominance, adjacent maxillary odontogenic pathology, and partial opacification of the sinus, compared to those with IH. These clinical features may aid earlier identification of MSFB without IH.

Background Neck dissection is an integral component of the treatment of head and neck cancers. The present meta-analysis aimed to compare the use of endoscope-assisted neck dissection (END) with conventional neck dissection (CND) in the existing English literature. Methods A search of PubMed (MEDLINE), Embase, and the Cochrane Library for articles reporting the results of the two techniques of neck dissection was completed independently by two individuals. The authors analyzed the data from each study using a random-effects model. Results The pooled analysis demonstrated comparable lymph node yield, intraoperative blood loss, incidence of locoregional recurrence, and incidence of complications between the two groups. A significantly longer operative time but a shorter length of hospital stay was observed in the END group compared with the other group. Conclusions Compared with conventional techniques, END offers similar oncologic outcomes and complication rates; however, it requires a longer operative time. Future studies with long-term follow-up and assessment of patient satisfaction are needed to confirm the clinical use of END. Graphical abstract