The role of fungi in diseases of the nose and sinuses

Abstract

Background: Human exposure to fungal elements is inevitable, with normal respiration routinely depositing fungal hyphae within the nose and paranasal sinuses. Fungal species can cause sinonasal disease, with clinical outcomes ranging from mild symptoms to intracranial invasion and death. There has been much debate regarding the precise role fungal species play in sinonasal disease and optimal treatment strategies.

Methods: A literature review of fungal diseases of the nose and sinuses was conducted.

Results: Presentation, diagnosis, and current management strategies of each recognized form of fungal rhinosinusitis was reviewed.

Conclusion: Each form of fungal rhinosinusitis has a characteristic presentation and clinical course, with the immune status of the host playing a critical pathophysiological role. Accurate diagnosis and targeted treatment strategies are necessary to achieve optimal outcomes.

Figure 1.

Fungal ball. Computed tomography (CT) scan shows hyperattenuated focus with complete opacification of right maxillary sinus.

Figure 2.

Allergic fungal rhinosinusitis. T1-weighted MRI with contrast shows enhancing mucosa characteristic of polyps in the ethmoid, frontal, and maxillary sinuses.

Figure 3.

Acute invasive fungal rhinosinusitis. Computed tomography (CT) scan with bone (top) and soft tissue (bottom) windowing showing destruction of left lamina papyracea with inflammation of orbital tissues.

Figure 4.

Acute invasive fungal rhinosinusitis. T1-weighted MRI scan with contrast showing enhancement of left retroantral soft tissues.

Figure 5.

Chronic invasive fungal rhinosinusitis. Computed tomography (CT) scan shows maxillary sinus opacification, erosion of orbital floor, and erosion of zygoma.