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Clinical pattern of fungal balls in the paranasal sinuses: our experience with 70 patients

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Many physicians recommend endoscopic sinus surgery (ESS) even when an asymptomatic paranasal sinus (PNS) fungal ball is detected incidentally. The aim of this study was to investigate the natural behavior of PNS fungal balls via sinus imaging techniques.

Methods

A follow-up study of 74 pathologically confirmed fungus balls was conducted in 70 patients who underwent multiple head and neck computed tomography (CT) scans or magnetic resonance imaging (MRI). We investigated the changes in symptoms and lesion size, as well as any new occurrences.

Results

Of the 74 fungus balls detected in 70 patients, we observed the renewed formation of a fungal ball in 21 patients, which was not present on initial imaging conducted over a period of 2–162 months. The fungal ball was already present in 53 patients on the initial screening, and the longest follow-up was 197 months (range 1–197 months). Of these 53 lesions, 29 lesions showed an increase in size (29/53, 54.7%), whereas 12 lesions were not associated with any clinical symptoms (12/53, 22.6%). In the 21 newly formed fungal balls, further development was observed in 10 lesions, with 4 lesions showing an increase in size. Thus, size increment occurred in 33 of the 57 fungus balls.

Conclusions

The fungal balls can exist without local tissue invasion for up to 17 years and new formation of the fungal balls was observed even within 2 months, especially when accompanied by initial clinical symptoms of sinusitis.

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References

  1. Thompson GR 3rd, Patterson TF (2012) Fungal disease of the nose and paranasal sinuses. J Allergy Clin Immunol 129:321–326

    Article  PubMed  Google Scholar 

  2. Grosjean P, Weber R (2007) Fungus balls of the paranasal sinuses: a review. Eur Arch Otorhinolaryngol 264:461–470

    Article  PubMed  Google Scholar 

  3. Dufour X, Kauffmann-Lacroix C, Ferrie JC, Goujon JM, Rodier MH, Karkas A, Klossek JM (2005) Paranasal sinus fungus ball and surgery: a review of 175 cases. Rhinology 43:34–39

    PubMed  Google Scholar 

  4. Raz E, Win W, Hagiwara M, Lui YW, Cohen B, Fatterpekar GM (2015) Fungal sinusitis. Neuroimaging Clin N Am 25:569–576

    Article  PubMed  Google Scholar 

  5. Zinreich SJ, Kennedy DW, Malat J, Curtin HD, Epstein JI, Huff LC, Kumar AJ, Johns ME, Rosenbaum AE (1988) Fungal sinusitis: diagnosis with CT and MR imaging. Radiology 169:439–444

    Article  CAS  PubMed  Google Scholar 

  6. Dhong HJ, Jung JY, Park JH (2000) Diagnostic accuracy in sinus fungus balls: CT scan and operative findings. Am J Rhinol 14:227–231

    Article  CAS  PubMed  Google Scholar 

  7. Nicolai P, Lombardi D, Tomenzoli D, Villaret AB, Piccioni M, Mensi M, Maroldi R (2009) Fungus ball of the paranasal sinuses: experience in 160 patients treated with endoscopic surgery. Laryngoscope 119:2275–2279

    Article  PubMed  Google Scholar 

  8. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD (2015) Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 152:S1–S39

    Article  PubMed  Google Scholar 

  9. Ponikau JU, Sherris DA, Kern EB, Homburger HA, Frigas E, Gaffey TA, Roberts GD (1999) The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 74:877–884

    Article  CAS  PubMed  Google Scholar 

  10. Leroux E, Valade D, Guichard JP, Herman P (2009) Sphenoid fungus balls: clinical presentation and long-term follow-up in 24 patients. Cephalalgia 29:1218–1223

    Article  CAS  PubMed  Google Scholar 

  11. Bekker AY, Weeks EJ (2003) Cognitive function after anaesthesia in the elderly. Best Pract Res Clin Anaesthesiol 17:259–272

    Article  PubMed  Google Scholar 

  12. Pedersen T, Eliasen K, Henriksen E (1990) A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 34:144–155

    Article  CAS  PubMed  Google Scholar 

  13. Akimoto T, Saito O, Inoue M, Nishino K, Onishi A, Kotoda A, Ando Y, Muto S, Kusano E (2007) Rapid formation of Aspergillus mycetoma in a patient receiving corticosteroid treatment. Serial radiographic observation over two months. Intern Med 46:733–737

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea

    Min Young Seo & Seung Hoon Lee

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Gwanghui Ryu, Sang Duk Hong, Hyo Yeol Kim, Hun-Jong Dhong & Seung-Kyu Chung

Authors
  1. Min Young Seo
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  2. Seung Hoon Lee
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  3. Gwanghui Ryu
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  4. Sang Duk Hong
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  5. Hyo Yeol Kim
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  6. Hun-Jong Dhong
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  7. Seung-Kyu Chung
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Corresponding author

Correspondence to Seung-Kyu Chung.

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Conflict of interest

All authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This study protocol was reviewed and approved by the Institutional Ethics Committee at the Samsung Medical Center (IRB number: SMC 2017-11-049).

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Seo, M.Y., Lee, S.H., Ryu, G. et al. Clinical pattern of fungal balls in the paranasal sinuses: our experience with 70 patients. Eur Arch Otorhinolaryngol 276, 1035–1038 (2019). https://doi.org/10.1007/s00405-018-5258-z

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  • DOI: https://doi.org/10.1007/s00405-018-5258-z

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