Abstract
Fungal rhinosinusitis accounts for a significant portion of paranasal sinus diseases, with fungus ball being the most frequently observed form, constituting 27% of cases. While commonly affecting the maxillary sinus, sphenoid sinus localization occurred in 24.78% of cases. Managing fungal balls in the sphenoid sinus poses challenges because of their proximity to critical structures, necessitating a careful and effective approach. A retrospective analysis was conducted on patients diagnosed with a paranasal sinus fungal ball, specifically isolated sphenoidal localization. Trans-nasal sphenoidotomy was performed, and the patients were followed up postoperatively for recurrence or residual disease. Among four identified cases, headache was the predominant symptom, and all patients underwent successful endoscopic surgery without complications. The follow-up revealed no recurrence or residual disease. Fungal ball in the sphenoid sinus, although uncommon, present diagnostic challenges with symptoms that often mimic other conditions. CT scans play a crucial role in diagnosis and reveal dense masses with characteristic features. Surgical intervention, particularly endoscopic sphenoidotomy, remains the primary and successful treatment, emphasizing the importance of early detection. This study emphasizes the effectiveness of endoscopic sphenoidotomy for managing isolated sphenoid sinus fungal ball. This also highlights the importance of early detection and treatment to prevent complications. Headache, a primary symptom, was successfully resolved after surgery, reinforcing the role of surgery as the primary treatment.
Similar content being viewed by others
References
Shetty S, Chandrashekar S, Aggarwal N (2020) A study on the prevalence and clinical features of fungal sinusitis in chronic rhinosinusitis. Indian J Otolaryngol Head Neck Surg 72:117–122. https://doi.org/10.1007/s12070-019-01769-w
Deutsch PG, Whittaker J, Prasad S (2019) Invasive and non-invasive fungal rhinosinusitis—a review and update of the evidence. Medicina (B Aires) 55:319. https://doi.org/10.3390/medicina55070319
Chaganti P, Rao N, Devi K et al (2020) Study of fungal rhinosinusitis. J Dr NTR Univ Health Sci 9:103. https://doi.org/10.4103/jdrntruhs.jdrntruhs_98_20
Pagella F, Pusateri A, Matti E et al (2011) Sphenoid sinus fungus ball: our experience. Am J Rhinol Allergy 25:276–280. https://doi.org/10.2500/ajra.2011.25.3639
Lawson W, Reino AJ (1997) Isolated sphenoid sinus disease: an analysis of 132 cases. Laryngoscope 107:1590–1595. https://doi.org/10.1097/00005537-199712000-00003
Popolizio T, Perri M, Balzano RF, Al-Badayneh B, Izzo R, Graziano P et al (2018) Isolated fungus ball in sphenoid sinus: tips and pitfalls of T1 hyperintense lesions. BJR|Case Rep 4(2):20170081
Lee TJ, Huang SF, Chang PH (2009) Characteristics of isolated sphenoid sinus aspergilloma: report of twelve cases and literature review. Ann Otol Rhinol Laryngol 118(3):211–217
Pagella F, Matti E, De BF et al (2007) Paranasal sinus fungus ball: diagnosis and management. Mycoses 50:451–456. https://doi.org/10.1111/j.1439-0507.2007.01416.x
Gungor A, Adusumilli V, Corey JP (1998) Fungal sinusitis: progression of disease in immunosuppression—a case report. Ear Nose Throat J 77(207–10):215
deShazo RD, Chapin K, Soto-Aguilar M et al (1997) Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol 99:475–485
Ence BK, Gourley DS, Jorgensen NL et al (1990) Allergic fungal sinusitis. Am J Rhinol 4:169–178. https://doi.org/10.2500/105065890782009415
Toussain G, Botterel F, Alsamad IA et al (2012) Sinus fungal balls: characteristics and management in patients with host factors for invasive infection. Rhinology 50:269–276. https://doi.org/10.4193/Rhino11.223
Chakrabarti A, Denning DW, Ferguson BJ et al (2009) Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope 119:1809–1818. https://doi.org/10.1002/lary.20520
Liu X, Liu C, Wei H et al (2020) A retrospective analysis of 1,717 paranasal sinus fungus ball cases from 2008 to 2017. Laryngoscope 130:75–79
Lee L, Huang C, Lee T (2004) Prolonged visual disturbance secondary to isolated sphenoid sinus disease. Laryngoscope 114:986–990. https://doi.org/10.1097/00005537-200406000-00006
Kim JS, Kim BK, Hong SD et al (2016) Clinical characteristics of sphenoid sinus fungal ball patients with visual disturbance. Clin Exp Otorhinolaryngol 9:326–331. https://doi.org/10.21053/ceo.2015.01571
Klossek J, Serrano E, Péloquin L et al (1997) Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses. Laryngoscope 107:112–117. https://doi.org/10.1097/00005537-199701000-00021
Guy A, Guy A, Rahman M et al (2021) Unusual case presentation of fungal ball infection causing diabetes insipidus and seizure disorder. Radiol Case Rep 16:789–794. https://doi.org/10.1016/j.radcr.2021.01.030
Dufour X, Kauffmann-Lacroix C, Ferrie J-C et al (2005) Paranasal sinus fungus ball and surgery: a review of 175 cases. Rhinology 43:34–39
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Babu, A.R., Amulya, T.M., Sandhya, D. et al. Decoding the Complexity: A Case Series on Isolated Sphenoid Sinus Fungal Ball. Indian J Otolaryngol Head Neck Surg (2024). https://doi.org/10.1007/s12070-024-04627-6
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12070-024-04627-6