Fungus Ball of the Paranasal Sinuses: Analysis of Our Serie of Patients

Lop-Gros, Joan; Gras-Cabrerizo, Juan R.; Bothe-González, Carolina; Montserrat-Gili, Juan R.; Sumarroca-Trouboul, Anna; Massegur-Solench, Humbert

doi:10.1016/j.otoeng.2016.07.002

Cited by 9 publications

(11 citation statements)

References 29 publications

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“…According to recent recommendations of scientists, using the old nonspecific terms of "aspergillosis", "aspergilloma" and "mycetoma" is not appropriate 3,[6][7][8] . FB commonly appears in normal immunocompetent persons, at 60-70 years of age, although, in some retrospective studies, age ranged within 14-87 years.…”

Section: Fungus Ballmentioning

confidence: 99%

“…Ethmoid sinuses involvement (1-15%) is often associated with the maxillary sinus pathology, frontal sinus involvement being much rarer. Multi-sinus localization was found only in 6-41% of the cases, the impairment of two sinuses being described in 3.3-10.3% of the cases, and of three sinuses in 5.8-17.2% 3,[6][7][8]11 . According to recent studies, FB represents 3.7% of all cases of inflammatory chronic rhinosinusitis (CRS) requiring surgery 9 .…”

Section: Fungus Ballmentioning

confidence: 99%

“…Symptoms are usually long lasting, may be present for months or even years, and FB can be detected occasionally. About 18% of patients may be asymptomatic and 10% present nasal polyposis 3,6,7,9,22,23 . Nasal endoscopic examination is nonspecific in most cases.…”

mentioning

confidence: 99%

“…• presence of an image of "metallic tone" intrasinusally, with the appearance of a foreign body; • existence of multiple calcifications or microcalcifications on the sinus opacity side; • heterogeneous content, unilateral or, rarely, in more sinuses; • lack of osteolysis areas, possibly only a bone erosion, probably caused by the prolonged mechanical compression, exerted by the FB in the bony walls 3,6,7,9,22 . Nevertheless, the clinical sensitivity of the CT is about 62%, the specificity -99%, the false positive rate -22% and the false negative rate -2%.…”

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confidence: 99%

“…The hyphae branch in a 45° angle and measure 3-6 micrometers in diameter, and the sporulating structures reach up to 30 micrometers. Important for the positive diagnosis of FB are the lack of fungal invasion in the sinus mucosa, blood vessels or bone, the lack of allergic mucin in the sinuses, the lack of granulomatous reaction, even if non-granulomatous chronic inflammation can be observed in the mucosa 3,[6][7][8]22 . Direct mycological examination involves examining on the slide the caseous masses collected from the sinuses, visualizing under a microscope the mycelium filaments.…”

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confidence: 99%

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Literature review. Noninvasive fungal rhinosinusitis

Cojocari

Sandul

2017

Romanian Journal of Rhinology

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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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Section: Fungus Ballmentioning

confidence: 99%

Section: Fungus Ballmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Literature review. Noninvasive fungal rhinosinusitis

Cojocari

Sandul

2017

Romanian Journal of Rhinology

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A retrospective analysis of 1,717 paranasal sinus fungus ball cases from 2008 to 2017

Liu

Wei

et al. 2019

The Laryngoscope

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Objectives/Hypothesis: To analyze the epidemiological characteristics, clinical features, and the outcomes of histopathology and microbiology for fungus ball (FB) in the last 10 years in our department.Study Design: Database review. Methods: In total, 1,717 cases of FB were reviewed from the case database of Beijing Tongren Hospital (between 2008 and 2017). Epidemiologic data, clinical manifestations, histopathology, and microbiology were analyzed.Results: In the past 10 years, there has been a significant increase in patients with FB presenting at our department (P < .05). The mean age of patients with paranasal sinus FB was 54 years, and 67% of patients were female (1,156/1,717). The average age and female predominance were consistent with previous reports. In total, 1,626 cases (94.7%) were unilateral, and the most common location was the maxillary sinus (76.6%). Aspergillus spp. (72.8%) was the most abundant fungal species in our study. The direct smear positive rate was 68.6%, and the fungal culture rate was 22.6%. All cases were treated with functional endoscopic sinus surgery, with a very low rate of postoperative complications and reoperation (20/1,717).Conclusions: Histopathological and microbiological analyses are essential for the diagnosis of FB. Surgery is the most effective method of treatment. Direct smear after surgery is not necessary. Oral or topical antimycotic treatments are not recommended after surgery or during the perioperative period.

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Invasive Aspergillosis of Nose and Paranasal Sinus in COVID-19 Convalescents: Mold Goes Viral?

Shetty

Shilpa

Sivapuram

et al. 2022

Indian J Otolaryngol Head Neck Surg

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Invasive Aspergillosis of the paranasal sinus is an aggressive illness, particularly affecting the immunocompromised and rarely, the immunocompetent. COVID-19 has been shown to cause a derangement of immune parameters both during active infection and the convalescent period. A retrospective study was done from June 10th 2021 to September 10th 2021 on patients who underwent endoscopic debridement of the involved sinuses for post COVID fungal rhinosinusitis. This study included the patients who had Aspergillus infection from the isolated nasal tissue samples. Patient's information, complaints, history of COVID infection, clinical findings, investigations and treatment details were obtained from the records. 13 patients with post-COVID Invasive Fungal Sinusitis were identified. Symptom onset usually occurred within 1 month of COVID 19 diagnosis in all the patients. Nasal obstruction (84%) and headache (61%) were the most common symptoms. Computerized tomography imaging showed maxillary sinus involvement in all patients followed by ethmoid sinus in 76% of patients. Microbiological diagnosis and histopathological confirmation of Aspergillus species was done. All 13 patients underwent endoscopic debridement of the involved sinuses followed by anti-fungal therapy with Posaconazole. All responded well to the treatment with no recurrence till date. Admist an infinite number of Mucormycosis cases in this era of COVID-19 pandemic, we experienced a surge of Aspergillus infection during this second wave. Presentation at a young age, with no known co-morbidities, with minimal symptoms and history of COVID-19 infection are some of the important aspects to be considered in this series. A better morbidity outcome is expected when early detection and treatment is made in patients with post Covid-19 viral illness with Aspergillosis of nose and paranasal sinus.

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Fungus Ball of the Paranasal Sinuses: Analysis of Our Serie of Patients

Cited by 9 publications

References 29 publications

Literature review. Noninvasive fungal rhinosinusitis

Literature review. Noninvasive fungal rhinosinusitis

A retrospective analysis of 1,717 paranasal sinus fungus ball cases from 2008 to 2017

Invasive Aspergillosis of Nose and Paranasal Sinus in COVID-19 Convalescents: Mold Goes Viral?

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