Rare Presentations of Frontal Sinus Fungus Ball: A Systematic Review
Bárbara Okabaiasse Luizeti1, Lesley Ane Roks de Lima1, Jonas Willian Spies2,3
1Department of Medicine, Faculdade de Medicina, Universidade Cesumar, Maringá, Paraná, Brazil.
Abstract:
Introduction The sinus fungus ball is an agglomeration of debris and hyphae, mainly caused by Aspergillus fumigatus , within the paranasal sinus, commonly affecting a single sinus, and it only rarely affects the frontal sinus. Objective To identify the state of the art of fungus ball in paranasal sinuses, especially related to the epidemiology of the disease in the frontal sinus. Additionally, this article reports a rare case of fungus ball in the frontal sinus in an adult male, and discusses the variables of this condition related to the patient. Data Synthesis All of the 8 cases of fungus ball in the frontal sinus reported in this study affected male patients: 40% had unilateral disease, and 60%, bilateral disease, contrary to the incidence data of fungus ball in the other paranasal sinuses, which reports unilateral prevalence. However, in the present study, this index changes, with 50% of unilateral and 50% of bilateral incidence regarding frontal sinus involvement. The average age of the patients was 65.36 years (range: 60-74 years). The etiologic agent was Aspergillus spp., and the endonasal endoscopic therapeutic approach corresponded to 80% of cases, while frontal osteoplasty accounted for 20% of cases, reaffirming the prevalence data from other studies. Conclusion Despite being a low-incidence entity, frontal sinus fungus ball should be considered in patients with pain in the frontal region refractory to the usual clinical treatments.
Insights
Frontal sinus fungus balls, though rare, predominantly affect males and can present as unilateral or bilateral disease. Consider this condition in patients with persistent frontal pain unresponsive to standard treatments.
Area of Science:
- Otolaryngology
- Mycology
- Infectious Diseases
Background:
- Sinus fungus balls are accumulations of debris and hyphae, primarily caused by Aspergillus fumigatus, within the paranasal sinuses.
- While typically affecting a single sinus, frontal sinus involvement is rare.
Purpose of the Study:
- To review the current understanding of paranasal sinus fungus balls, focusing on the epidemiology of frontal sinus involvement.
- To report a rare case of frontal sinus fungus ball in an adult male and discuss associated patient variables.
Main Methods:
- Review of existing literature on frontal sinus fungus balls.
- Analysis of a specific case study involving an adult male patient.
Main Results:
- All reported cases (8) of frontal sinus fungus ball affected male patients.
- Incidence in this study showed 50% unilateral and 50% bilateral involvement, differing from other paranasal sinuses.
- The average patient age was 65.36 years, with Aspergillus spp. as the etiological agent; endoscopic surgery was the primary treatment (80%).
Conclusions:
- Frontal sinus fungus ball is an uncommon condition but should be considered in refractory frontal region pain.
- Understanding its epidemiological characteristics, particularly in males, is crucial for diagnosis and management.
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