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Natural Course of the Maxillary Sinus Fungus Ball: Results From Seoul National University Hospital Healthcare Center
Seung Cheol Han1, Junhyung Bae2, Jin-A Park3
1Department of Otorhinolaryngology-Head & Neck Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea.
Objectives:
The frequency of paranasal sinus fungus balls, a common form of rhinosinusitis, has increased. Although treatment and causative factors have been well investigated, the evolving nature of the fungal balls remains unelucidated. This study aimed to investigate and analyze the changing patterns of fungus balls.
Methods:
This retrospective study analyzed data from 35 participants selected from a pool of 41,497 patients who underwent brain magnetic resonance imaging (MRI) at a large health care center. The extent of the fungus balls was evaluated by grading them from 1 to 4 based on the MR images. The changing process of the fungus ball was analyzed based on demographics, interval between the MRI scans, comorbidities, and specific dental interventions.
Results:
The fungus ball grades showed significant progression over time. In the analysis of 29 sinuses with initially low-grade (grades 0, 1, and 2) fungus balls, 15 sinuses showed a grade change <2 (no/minimal change group), whereas 14 sinuses showed grade changes of ≥2 (substantial change group). Intergroup comparison showed that only the interval between the initial and final MRI scans differed significantly (p = 0.008). However, factors, such as age, sex, comorbidities, and history of dental procedures, did not differ significantly between the two groups.
Conclusion:
This study shows the extent of change in fungus balls, primarily over time. These results offer critical insights into the natural course and progression of the maxillary sinus fungus ball.
Level Of Evidence:
4 Laryngoscope, 135:1315-1320, 2025.
Insights
Paranasal sinus fungus balls show significant progression over time, with the interval between MRI scans being a key factor. This study reveals insights into the natural course of these fungal growths.
Area of Science:
- Otolaryngology
- Radiology
- Mycology
Background:
- Paranasal sinus fungus balls are a common form of rhinosinusitis with increasing prevalence.
- While treatments are known, the natural evolution of these fungal masses remains poorly understood.
Purpose of the Study:
- To investigate and analyze the changing patterns and progression of paranasal sinus fungus balls over time.
- To identify factors influencing the evolution of fungal sinusitis.
Main Methods:
- Retrospective analysis of 35 patients from 41,497 undergoing brain MRI.
- Fungus ball extent was graded (1-4) on MRI; progression was analyzed based on demographics, MRI intervals, comorbidities, and dental interventions.
Main Results:
- Fungus ball grades demonstrated significant progression over time.
- 14 out of 29 sinuses with low-grade fungus balls showed substantial grade changes (≥2).
- The interval between MRI scans was the only significant factor associated with grade change (p=0.008).
Conclusions:
- Paranasal sinus fungus balls exhibit significant changes primarily driven by time.
- Findings provide crucial insights into the natural history and progression of maxillary sinus fungus balls.
