Frontal Sinus Fungus Ball: a rare case and literature review

Abstract

Aims: This article describes the report of a rare case of fungal ball in the frontal sinus in an adult male and discuss about the variables of this condition related to the patient. Additionally, this study aims to identify the state of the art of fungal ball in paranasal sinuses, especially in the frontal sinus. Method: We performed a literature review on fungal ball in the paranasal sinuses and described a rare case of fungal ball in the frontal sinus, which is listed as the paranasal sinus most rarely affected by fungal ball. Result: All reported cases of fungus ball in the frontal sinus affected male patients, contrary to the common prevalence of females in fungal ball of the other paranasal sinuses. Of the total of 8 patients with fungal ball in the frontal sinus reported, 40% had unilateral disease and 60% bilateral, also contrary to the incidence data of the other paranasal sinuses, with unilateral prevalence. However, with the present study, this index changes, with 50% unilateral and 50% bilateral in frontal sinus involvement. The average age of cases reported in the frontal sinus is 65.29 years, with a minimum age of 61.16 and a maximum of 69 years. As for the etiologic agent, Aspergillus sp., the endonasal endoscopic therapeutic approach corresponded to 80% of cases, while frontal osteoplasty accounted for 20% of cases, reaffirming this prevalence data from other studies. Conclusion: Despite being a low incidence entity, frontal sinus fungal ball should be considered in patients with pain in the frontal region refractory to the usual clinical treatments. We hope to contribute to the knowledge of this presentation as a differential diagnosis and reinforce the importance of thorough clinical investigation.