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Fungal Rhinosinusitis: A Radiological Review With Intraoperative Correlation
Elaine Ni Mhurchu1, Javier Ospina2, Arif S Janjua2
1Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Abstract:
The interaction between fungi and the sinonasal tract results in a range of clinical presentations with a broad spectrum of clinical severity. The most commonly accepted classification system divides fungal rhinosinusitis into invasive and noninvasive subtypes based on histopathological evidence of tissue invasion by fungi. Invasive fungal rhinosinusitis is subdivided into acute invasive and chronic invasive categories. The chronic invasive category includes a subcategory of chronic granulomatous disease. Noninvasive fungal disease includes localized fungal colonization, fungal ball, and allergic fungal rhinosinusitis. Noninvasive disease is simply fungal material (or the products of the inflammatory reaction of the sinus mucosa) that fills the sinuses but does not invade tissue. Bone loss is related to expansion of the sinus(es). Invasive disease causes tissue destruction, such that it expands past the bony confines of the sinuses. It can rapidly spread, causing acute necrosis. Alternatively, there may be slow tissue invasion characterized by symptoms confused with normal sinusitis, but destruction of normal nasal and paranasal structures.
Insights
Fungal rhinosinusitis involves fungal presence in the sinuses, classified as invasive or noninvasive. Invasive types destroy tissue, while noninvasive types fill sinuses without invasion, impacting sinonasal health.
Area of Science:
- Otolaryngology
- Mycology
- Pathology
Background:
- Fungal rhinosinusitis presents with diverse clinical severity.
- A key classification distinguishes invasive from noninvasive fungal rhinosinusitis based on tissue invasion.
Purpose of the Study:
- To elucidate the classification and characteristics of fungal rhinosinusitis.
- To differentiate between invasive and noninvasive fungal disease presentations.
Main Methods:
- Histopathological examination to identify fungal invasion.
- Clinical assessment of sinonasal tract interactions with fungi.
Main Results:
- Noninvasive fungal rhinosinusitis includes fungal colonization, fungal balls, and allergic fungal rhinosinusitis, characterized by fungal material without tissue invasion.
- Invasive fungal rhinosinusitis, including acute and chronic forms (with chronic granulomatous disease as a subcategory), involves tissue destruction and potential rapid spread.
- Bone loss is observed in noninvasive disease due to sinus expansion, whereas invasive disease causes destructive tissue damage beyond sinus confines.
Conclusions:
- Accurate classification of fungal rhinosinusitis is crucial for understanding disease progression.
- Distinguishing between invasive and noninvasive fungal rhinosinusitis guides diagnosis and management strategies.
- Fungal infections of the sinonasal tract range from localized colonization to aggressive tissue destruction.
