Fungus ball of the paranasal sinuses. Case Series

Abstract

Introduction: A fungus ball (FB) is a non-invasive fungal sinusitis, consisting of ex- tramucosal accumulation of dense fungal hyphae conglomerates, located in paranasal sinuses. It generally affects immunocompetent women. Aim: To describe the clinical presentation, diagnosis and treatment in a series of patients diagnosed with FB of paranasal sinuses. Material and method: Retrospective descriptive study regarding all patients with a histopathologic diagnosis of FB, who underwent endoscopic sinus surgery (ESS) in our institution between 2010 and 2016. Results: Twenty patients (15 women, 5 men) were included, with a mean age at diagnosis of 64 years (35-86 years). Most were immunocompetent (85%). Facial pain was the most frequent symptom (8/20). All patients were studied with a sinus CT, finding paranasal calcifications in 70%. It predominantly involved the maxillary (12/20), and sphenoid sinus (6/20). All patients were treated with ESS, with a combined Caldwell Luc approach in only 3 of them. Intraoperative cultures were negative in 75% of patients. Conclusions: Sinus FB has a non-specific clinical presentation. CT findings help suspect it, and it is confirmed with a histopathological study, given the poor efficiency of cultures. ESS is the diagnostic-therapeutic procedure of choice, with a low local recurrence rate.