Septal Deviation Is Associated with Maxillary Sinus Fungus Ball in Male Patients

Abstract

Fungus is one of the causes of chronic rhinosinusitis. If the fungus occupies the sinus but does not invade the sinonasal mucosa, this is called sinus fungus ball. Any association between anatomical variations and fungus ball remains unclear. Sinus fungus ball is defined as non-invasive chronic fungal rhinosinusitis occurring in immunocompetent patients, and the maxillary sinus is the most commonly affected. The etiology of maxillary sinus fungus ball remains unclear. This study assessed the potential contribution of anatomical variations, such as deviated nasal septum, concha bullosa, and Haller cell to the development of fungus ball in the maxillary sinus. Concha bullosa and Haller cell are structural variations that narrow the nasal airflow passage and contribute to chronic rhinosinusitis. The involvement of these variations has been investigated in chronic sinusitis but not in sinus fungus ball. Preoperative computed tomography findings of 103 patients with maxillary sinus fungus ball were evaluated retrospectively. Septal deviation and Haller cell were not correlated with the side of maxillary sinus fungus ball. Concha bullosa was more common on the unaffected side (p = 0.099). When we analyzed males and females separately, maxillary sinus fungus ball was more common on the concave side of the deviated septum in only male patients (p = 0.006). The high incidence of maxillary fungus ball in the concave side may reflect the consequences of the traumatic effects caused by wall shear stress of the high-velocity airflow and the increased chance of inhaling fungus spores.

Volumetric analysis of the maxillary sinus in pediatric patients with nasal septal deviation

“…emphasized that nasal septal deviation sped up the nasal air flow and this might increase the inhalation of the fungus balls. [24] Fadda et al stated that it was necessary to pay attention to nasal and sinusoidal anatomic variations in the examination of CTs of the patients with recurrent chronic rhinosinusitis and the rate of infection in maxillary sinus might increase in cases that may cause trouble in air flow such as nasal deviation. [25] In our study, we researched the effect of nasal septal deviation on the maxillary volume.…”

Fungus ball in concha bullosa

“…[1,2] However, it has also been reported that the maxillary sinus FB is more often seen at the concave part of a deviated septum in male patients. [5]…”

Literature review. Noninvasive fungal rhinosinusitis

“…The FB sinus pathophysiology remains unknown. The disorder develops in two conditions: penetration of hyphae and fungal spores into a paranasal sinus and creating the environment that contribute to the growth of fungi 9,12,13 . Three possible theories of FB development have been suggested: airborne, odontogenic and mixed.…”

“…According to the airborne theory, large quantities of fungal spores in the air penetrate the sinuses through the natural ostia, multiply and become pathogenic when the sinus becomes an anaerobic environment. A possible cause may be the ostiomeatal obstruction, accentuated by anatomical factors (septum deviation, turbinate hypertrophy) contributing to the stasis occurred inside the sinuses, with the development of a hypoxic and anaerobic environment, with the lowering of the pH -a favourable and ideal condition for the proliferation of fungi and increasing the possibility of allergic reactions 9,12,13 . The odontogenic path is a iatrogenic one, where fungal colonization of the maxillary sinus occurs through a iatrogenic oro-antral communication, secondary to dental extraction, by periodontal lesions, channel perforation or, most frequently, after endodontic treatment with overfilling of the dental channel.…”

“…The metals from the endodontic material, particularly zinc oxide, titanium, lead, calcium salts, barium and sulfur, accidentally introduced into the maxillary sinus during the endodontic treatment of the maxillary teeth, have a key role in the growth of fungi, the gradual filling of the sinuses and in the FRS pathogenesis. However, the odontogenic theory does not explain the FB occurrence in the ethmoid, sphenoid, frontal sinuses or in the maxillary sinuses of patients who have no history of dental pathology 9,12,13 .…”