Paranasal fungus ball infection: Review of the literature with 15 cases
Ibrahim Ketenci1, Yaşar Ünlü1, Kerem Kökoğlu2, Mehmet İlhan Şahin1
1Erciyes Üniversitesi, Tıp Fakültesi Kulak Burun Boğaz Hastalıkları Anabilim Dalı, Kayseri, Türkiye
2Develi Devlet Hastanesi Kulak Burun Boğaz Hastalıkları Kliniği, Kayseri, Türkiye
Keywords: Aspergillus, fungus ball, paranasal sinus.
Abstract
OBJECTIVE: This study aims to review the paranasal fungus ball literature with 15 cases.
METHODS: Fifteen patients (6 males, 9 females; mean age 56.2 years; range, 33 to 86 years) who underwent functional endoscopic sinus surgery (FESS) or modified Caldwell Luc approach applied and met the deShazo diagnostic criteria were included in the study. Patients’ detailed histories, physical and endoscopic examinations, complete blood count results, imaging findings, operative reports, and mycological and histopathological findings were reviewed retrospectively.
RESULTS: While 12 patients had no other accompanying disease, one patient had lymphoma, one patient had liver failure and one patient had diabetes mellitus. Major symptoms were face and head pain in 13 patients and nasal obstruction in two patients. There was dental instrumentation history in one patient. According to preoperative blood values, no patient had eosinophilia. No patient had any history of pulmonary aspergillosis or asthma. In preoperative imaging examination, seven patients had sphenoidal and seven patients had maxillary sinus involvement. In one patient, the fungus ball was localized in the middle concha. The most frequently observed finding in computed tomography was heterogeneous opacity in the involved sinuses in all patients. Seven patients had irregular calcifications and heterogeneous appearances within these areas. Of the patients, 13 were operated by FESS and two by modified Caldwell Luc procedure. When intraoperative findings were examined, there were granulation and polypoid tissues surrounding the sinus ostium in sphenoidal sinus-induced patients. Of the 15 patients, three had nasal polyposis. Specimens had no positive culture results. Non-invasive fungus hyphae were seen microscopically by periodic acid-Schiff staining. Three patients had additional microscopy compatible with nasal polyp. None of the patients was administered pre- or postoperative systemic or local antifungal treatment.
CONCLUSION: Paranasal fungus ball is an infection that should come to mind in the differential diagnosis of sinusitis of this region with typical imaging finding that does not require antifungal and may be treated surgically.