The changing face of paranasal sinus fungus balls
Ashley B Robey1, Erin K O'Brien, Brynn E Richardson
1Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-1225, USA.
Objectives:
We describe the clinical, radiographic, and histopathologic characteristics of fungus balls.
Methods:
We performed a retrospective review of 24 consecutive patients with the diagnosis of a paranasal sinus fungus ball (mycetoma) from 2001 to 2008.
Results:
We found that 18 of the 24 primarily involved sinuses had bony thickening, and 13 of the 24 had notable dilatation of the ostium. Eleven of the 24 patients were found to have some degree of immunocompromise (from organ transplantation, diabetes, etc). The patient's immune status correlated with the type of fungus involved. (Mucor-like fungi were more common in immunocompetent patients, and aspergillus-like fungi were more common in immunocompromised patients.) Also, there was a predilection for immunocompetent patients to have dilatated ostia, whereas immunocompromised patients were more likely to have a nondilatated ostium (p = 0.019).
Conclusions:
Our series of paranasal sinus fungus balls defines a group of patients heretofore poorly described in the literature. Our data reveal an increased incidence in immunocompromised patients. We also found consistent radiographic patterns, correlations between immune status and the fungal pathogen, correlations between ostial enlargement and immune status, and the presence of cranial nerve pareses. These represent new findings that merit further study.
Insights
Fungus balls in the sinuses are more common in immunocompromised patients and show distinct radiographic patterns. Immune status correlates with fungal type and sinus ostium size, offering new insights into this condition.
Area of Science:
- Otolaryngology
- Mycology
- Immunology
Background:
- Fungus balls, also known as mycetoma, are a common fungal infection of the paranasal sinuses.
- The clinical, radiographic, and histopathologic characteristics of paranasal sinus fungus balls are not well-defined.
Purpose of the Study:
- To describe the clinical, radiographic, and histopathologic characteristics of paranasal sinus fungus balls.
- To investigate the correlation between patient immune status and fungal pathogens.
- To identify potential radiographic predictors of paranasal sinus fungus balls.
Main Methods:
- Retrospective review of 24 patients diagnosed with paranasal sinus fungus balls between 2001 and 2008.
- Analysis of clinical data, radiographic findings (including bony thickening and ostial dilatation), and histopathologic results.
- Correlation of patient immune status with fungal type and radiographic features.
Main Results:
- 18/24 sinuses showed bony thickening; 13/24 had ostial dilatation.
- 11/24 patients were immunocompromised.
- Mucor-like fungi were more prevalent in immunocompetent patients, while Aspergillus-like fungi were more common in immunocompromised patients.
- Immunocompetent patients showed a predilection for dilated ostia, whereas immunocompromised patients were more likely to have non-dilated ostia (p=0.019).
Conclusions:
- This study defines characteristics of paranasal sinus fungus balls, highlighting an increased incidence in immunocompromised individuals.
- Consistent radiographic patterns, correlations between immune status and fungal pathogens, and ostial enlargement were identified.
- New findings regarding immune status, fungal type, ostial size, and cranial nerve involvement warrant further investigation.
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