Abstract
A generally fit and well 63-year-old lady presented to her GP complaining about retro-orbital headache and mucopurulent discharge. She was initially treated as having a common cold. Later on, the patient developed double vision and ptosis on the left eye. She was subsequently referred to our department for further investigations and definite treatment. On clinical examination, she complained about persistent nasal congestion and mucopurulent discharge. Headache and opthalmological symptoms deteriorated over the time. Flexible nasendoscopy revealed mucopurulent discharge coming from the sphenoethmoidal recess. Ophthalmology review confirmed left oculomotor nerve palsy while CT scan showed complete opacification of the left sphenoid sinus and thickening of the sinus walls (Fig. 14.1). She was started empirically on intravenous broad spectrum antibiotics with no significant clinical improvement. The patient underwent endoscopic sinus surgery, during which the surgeon identified debris coming out of the widened sphenoid ostium (Fig. 14.2). Histological evaluation of the specimen showed nonseptate fungal colonies accompanied by cellular debri and numerous neutrophils. The patient was under regular follow up for 6 months, and no recurrence was noted. Endoscopic evaluation of the nose was unremarkable and the ocular symptoms eventually improved.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Bibliography
Chakrabarti A, Denning DW, Ferguson BJ, Ponikau J, Buzina W, Kita H, Marple B, Panda N, Vlaminck S, Kauffmann-Lacroix C, Das A, Singh P, Taj-Aldeen SJ, Kantarcioglu AS, Handa KK, Gupta A, Thungabathra M, Shivaprakash MR, Bal A, Fothergill A, Radotra BD. Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope. 2009;119(9):1809–18.
Grosjean P, Weber R. Fungus balls of the paranasal sinuses: a review. Eur Arch Otorhinolaryngol. 2007;264:461–70.
Ferguson BJ. Definitions of fungal rhinosinusitis. Otolaryngol Clin N Am. 2000;33:227–35.
Montone KT. Pathology of fungal rhinosinusitis: a review. Head Neck Pathol. 2016;10:16–46.
Ferguson BJ. Fungus balls of the paranasal sinuses. Otolaryngol Clin N Am. 2000;33(2):389–98.
Dufour X, Kauffmann-Lacroix C, Ferrie JC, Goujon JM, Rodier MH, Klossek JM. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989–2002. Med Mycol. 2006;44(1):61–7.
Mensi M, Piccioni M, Marsili F, Nicolai P, Sapelli PL, Latronico N. Risk of maxillary fungus ball in patients with endodontic treatment on maxillary teeth: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:433–6.
Legent F, Billet J, Beauvillain C, Bonnet J, Miegeville M. The role of dental canal fillings in the development of Aspergillus sinusitis. A report of 85 cases. Arch Otorhinolaryngol. 1989;246(5):318–20.
Zinreich SJ, Kennedy DW, Malat J, Curtin HD, Epstein JI, Huff LC, Kumar AJ, Johns ME, Rosenbaum AE. Fungal sinusitis: diagnosis with CT and MR imaging. Radiology. 1988;169(2):439–44.
Broglie MA, Tinguely M, Holzman D. How to diagnose sinus fungus balls in the paranasal sinus? An analysis of an institution’s cases from January 1999 to December 2006. Rhinology. 2009;47:379–84.
deShazo RD, O’Brien M, Chapin K, Soto-Aguilar M, Swain R, Lyons M, Bryars WC Jr, Alsip S. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol. 1997;99(4):475–85.
Adelson RT, Marple BF. Fungal rhinosinusitis: state-of-the-art diagnosis and treatment. J Otolaryngol. 2005;34(Suppl1):S18–22.
Manning SC, Shaefer SO, Close LG, et al. Culture-positive allergic fungal sinusitis. Arch Otolaryngol Head Neck Surg. 1991;117:174–8.
Glass D, Amedee RG. Allergic fungal rhinosinusitis: a review. Ochsner J. 2011;11:271–5.
Loftus PA, Wise SK. Allergic fungal rhinosinusitis: the latest in diagnosis and management. Adv Otorhinolaryngol. 2016;79:13–20.
Daniel Glass, Ronald G. Amedee. Allergic fungal rhinosinusitis: a review. Ochsner J 11:271–275, 2011
Cojocari L, Sandul A. Literature review. Non-invasive fungal rhinosinusitis. Rom J Rhinol. 2017;7(26):75–81.
Bent JP, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg. 1994;111(5):580–8.
Rupa V, Jacob M, Mathews MS, Seshadri MS. A prospective, randomised, placebo-controlled trial of post-operative oral steroid in allergic fungal sinusitis. Eur Arch Otorhinolaryngol. 2010;267:233–8.
Kuhn FA, Javer AR. Allergic fungal sinusitis: a four-year follow-up. Am J Rhinol. 2000;14:149–56.
Gan EC, Thamboo A, Rudmik L, Hwang PH, Ferguson BJ, Javer AR. Medical management of allergic fungal rhinosinusitis following endoscopic sinus surgery: an evidence-based review and recommendations. Int Forum Allergy Rhinol. 2014;4:702–15.
Khalil Y, Tharwat A, Abdou AG, et al. The role of antifungal therapy in the prevention of recurrent allergic fungal rhinosinusitis after functional endoscopic sinus surgery: a randomized, controlled study. Ear Nose Throat J. 2011;90:E1–7.
Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012;50:1–12.
Mabry RL, Mabry CS. Allergic fungal sinusitis: the role of immunotherapy. Otolaryngol Clin N Am. 2000;33:433–40.
Ren L, Zhang N, Zhang L, Bachert C. Biologics for the treatment of chronic rhinosinusitis with nasal polyps—state of the art. World Allergy Organ J. 2019;12(8):100050.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Tsetsos, N., Stavrakas, M., Karkos, P.D. (2021). Non-invasive Fungal Rhinosinusitis. In: Stavrakas, M., Khalil, H.S. (eds) Rhinology and Anterior Skull Base Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-66865-5_14
Download citation
DOI: https://doi.org/10.1007/978-3-030-66865-5_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-66864-8
Online ISBN: 978-3-030-66865-5
eBook Packages: MedicineMedicine (R0)