Invasive and Allergic Fungal Sinusitis

Fungal sinusitis encompasses a wide range of clinical syndromes. Disease is classified into four major categories: 1) acute invasive fungal sinusitis, 2) chronic invasive fungal sinusitis, 3) mycetoma, and 4) allergic fungal sinusitis. Acute disease is most often a fulminant, life-threatening process seen in immunocompromised patients. Treatment requires prompt antifungal therapy and extensive surgical debridement. Other types of fungal sinusitis are more indolent. For chronic invasive sinusitis, a combination of surgical debridement and antifungal agents is the cornerstone of treatment. Mycetomas can usually be extirpated surgically and do not require therapy with antifungal agents. Treatment of allergic fungal sinusitis remains controversial, but most current management regimens utilize surgical debridement combined with corticosteroid therapy, rather than antifungal agents.