Paranasal sinus fungus balls

Abstract

Background Paranasal sinus fungus balls (mycetomas) are a form of fungal sinus infection distinct from allergic fungal sinusitis, fulminant invasive fungal disease, and paranasal aspergillus granulomas. Methods The Mayo Clinic surgical pathology files of inflammatory sinus specimens from 1984 to 1994 were examined. Twenty‐nine paranasal sinus fungus balls were identified. Cases of allergic fungal sinusitis and invasive fungal disease were excluded. Results The fungus balls occurred in 11 men and 18 women, with an age range of 28 to 86 years, mean 64 years. Sinuses involved included maxillary (20 cases), sphenoid (10 cases), ethmoid (9 cases), and frontal (6 cases). In 12 patients, multiple sinuses were involved in a variety of combinations. By culture the most common pathogens were Aspergillus fumigatus and Aspergillus flavus. Treatment was by a variety of surgical procedures. Follow‐up in 28 patients showed two recurrences and three deaths due to intracerebral bleed as a complication of surgery. These deaths occurred in patients with sphenoid sinus fungus balls. Conclusions Paranasal sinus fungus balls occur in an elderly population and have a female predominance. They have a low morbidity and recurrence rate. Death can occur in sphenoid sinus lesions as a complication of surgery. © 1997 John Wiley & Sons, Inc. Head Neck 19:481–486, 1997.

The Changing Face of Paranasal Sinus Fungus Balls

“…1,[3][4][5][6] The computed tomographic (CT) appearance of a fungus ball has been described as complete or subtotal opacification of the involved sinus with heterogeneous, often calcified, material and either bony thickening or erosion of the sinus walls. 1,[3][4][5][6] The computed tomographic (CT) appearance of a fungus ball has been described as complete or subtotal opacification of the involved sinus with heterogeneous, often calcified, material and either bony thickening or erosion of the sinus walls.…”

“…1,[3][4][5][6] The computed tomographic (CT) appearance of a fungus ball has been described as complete or subtotal opacification of the involved sinus with heterogeneous, often calcified, material and either bony thickening or erosion of the sinus walls. 1,[4][5][6][7][8] In a review of the literature, a single article describing 4 cases involving skull base erosion from a sphenoid sinus fungus ball was located. However, these studies have not specifically characterized the incidence of specific sinus wall changes, including thickening and erosion.…”

“…However, these studies have not specifically characterized the incidence of specific sinus wall changes, including thickening and erosion. 4,6 Because of the high morbidity rate of these potential complications, further characterization of bony erosion according to site and organism is needed so that evaluation, treatment planning, and execution may be conducted safely and appropriately, whether by surgery alone or by surgery plus medical therapy. 1,[4][5][6][7][8] In a review of the literature, a single article describing 4 cases involving skull base erosion from a sphenoid sinus fungus ball was located.…”

Skull Base Erosion and Associated Complications in Sphenoid Sinus Fungal Balls

“…Operative cultures were much less sensitive for identifying fungus, with only 4 of 21 cases that resulted in a positive culture, as has been noted in other studies. 3,21 Ultimately, the diagnosis is dependent on the histopathologic presence of fungal forms rather than microbiologic evaluation. Limitations of the study included the retrospective nature of this review and the small number of patients with complications of SSFB in our series.…”

Sinus aspergilloma in rheumatoid arthritis before or during tumor necrosis factor-alpha antagonist therapy

“…Aspergilloma, also called fungus ball, is a clump of fungus growing in a cavity, in the lung or a sinus, often a maxillary sinus. Aspergilloma has been found in 3.7% of patients undergoing surgery for chronic inflammatory sinusitis [12]. …”