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. 2022 Mar 22:2022:6721896.
doi: 10.1155/2022/6721896. eCollection 2022.

The Endonasal Endoscopic Approach to Different Sinonasal Fungal Balls

Ali Almomen  1 , H Albaharna  2 , Aishah A AlGhuneem  3 , Batool Z AlZahir  4
Affiliations

The Endonasal Endoscopic Approach to Different Sinonasal Fungal Balls

Ali Almomen et al. Int J Otolaryngol. .

Abstract

Background: Fungal ball sinusitis is a sinonasal fungus ball that usually affects immunocompetent adults with female predominance. The most affected sinus is the maxillary sinus. Aspergillus species is the most typically found fungus. Computed tomography (CT) scan is the gold standard tool in order to diagnose fungal ball sinusitis. The ultimate method for a fungal ball is functional endoscopic sinus surgery (FESS), which has a high success rate and a low morbidity rate.

Objective: This study aims to demonstrate the various clinical presentations of fungal ball sinusitis including isolated maxillary sinus, sphenoid sinus, simultaneous occurrence of maxillary and sphenoid fungal ball, and post endonasal endoscopic pituitary surgery fungal ball with various age groups. Also, this study aims to emphasize the importance of early diagnosis and treatment in such cases. Patients and Methods. A retrospective study that was carried in the otorhinolaryngology department of two hospitals: King Fahad Specialist Hospital and Qatif Central Hospital, Eastern Region, Saudi Arabia. The study was conducted on a total of 16 patients who were diagnosed with paranasal sinuses fungal ball in an 11-year period from January 2008 and November 2019.

Results: Out of 16 patients with paranasal sinuses fungal ball, 11 cases were female and 5 males, with age ranging between 16 and 46 years. Results showed eight isolated sphenoid (50%), six isolated maxillary fungal ball (38%), one simultaneous occurrence of the sphenoid and maxillary fungal ball (6%), and one post endonasal endoscopic pituitary surgery for pituitary adenoma (6%). CT scan was performed for all 16 cases which is the standard tool for the diagnosis of the fungal ball.

Conclusion: Fungal ball may present with variety of symptoms but most commonly with postnasal discharge (PND), headache, and facial pain. CT sinuses is the diagnostic radiological modality to confirm the diagnosis. The FESS functional endoscopic sinus surgery is the gold safe approach for patients with fungal ball to manage their symptoms, confirm the diagnosis, and removal of disease with no morbidities.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1
Coronal CT sinuses showing right maxillary sinus fungal ball.
Figure 2
Figure 2
Axial CT sinuses showing right maxillary sinus fungal ball.
Figure 3
Figure 3
30-degree endoscopic view showing right maxillary fungal ball.
Figure 4
Figure 4
Postoperative endoscopic view showing wide middle meatus antrostomy with patent maxillary sinus.
Figure 5
Figure 5
Coronal CT sinuses showing left sphenoid sinus fungal ball.
Figure 6
Figure 6
Intraoperative endoscopic view showing left sphenoid sinus fungal ball.
Figure 7
Figure 7
Postoperative endoscopic view showing wide sphenoidectomy post removal of fungal debris.
Figure 8
Figure 8
0-degree intraoperative endoscopic view fungal balls filling both left maxillary and sphenoid sinuses.
Figure 9
Figure 9
Postoperative debridement and complete removal of fungal balls from both left maxillary and sphenoid sinuses.
Figure 10
Figure 10
Coronal CT scan sinuses showing a sphenoid opacity of fungal ball post endonasal endoscopic pituitary surgery.
Figure 11
Figure 11
Intraoperative endoscopic view showing the sphenoid is full with fungal debris post endonasal endoscopic pituitary surgery.
Figure 12
Figure 12
Postoperative endoscopic view showing a wide clean sphenoid sinus.
See this image and copyright information in PMC

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References

    1. Dufour X., Kauffmann-Lacroix C., Ferrie J. C., Goujon J. M., Rodier M. H., Klossek J. M. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France 1989–2002. Sabouraudia . 2006;44(1):61–67. - PubMed
    1. Jiang R. S., Huang W. C., Liang K. L. Characteristics of sinus fungus ball: a unique form of rhinosinusitis. Clinical Medicine Insights: Ear, Nose and Throat . 2018;11 doi: 10.1177/1179550618792254.1179550618792254 - DOI - PMC - PubMed
    1. Montone K. T. Pathology of fungal rhinosinusitis: a review. Head and neck pathology . 2016;10(1):40–46. doi: 10.1007/s12105-016-0690-0. - DOI - PMC - PubMed
    1. Yoon Y. H., Xu J., Park S. K., Heo J. H., Kim Y. M., Rha K. S. A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996–2015) International forum of allergy & rhinology . 2017;7(No. 11):1070–1075. doi: 10.1002/alr.22007. - DOI - PubMed
    1. Nomura K., Asaka D., Nakayama T., et al. Sinus fungus ball in the Japanese population: clinical and imaging characteristics of 104 cases. International Journal of Otolaryngology . 2013;2013:9. doi: 10.1155/2013/731640.731640 - DOI - PMC - PubMed

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