%0 Journal Article
%T Sinus Fungus Ball in the Japanese Population: Clinical and Imaging Characteristics of 104 Cases
%A Kazuhiro Nomura
%A Daiya Asaka
%A Tsuguhisa Nakayama
%A Tetsushi Okushi
%A Yoshinori Matsuwaki
%A Tsuyoshi Yoshimura
%A Mamoru Yoshikawa
%A Nobuyoshi Otori
%A Toshimitsu Kobayashi
%A Hiroshi Moriyama
%J International Journal of Otolaryngology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/731640
%X Sinus fungus ball is defined as noninvasive chronic fungal rhinosinusitis occurring in immunocompetent patients with regional characteristics. The clinical and imaging characteristics of paranasal sinus fungus ball were retrospectively investigated in 104 Japanese patients. All patients underwent endoscopic sinus surgery. Preoperative computed tomography (CT), magnetic resonance (MR) imaging, age, sex, chief complaint, causative fungus, and clinical outcome were analyzed. Patients were aged from 25 to 79 years (mean 58.8 years). Female predominance was noted (58.7%). Most common symptoms were nasal discharge and facial pain. CT showed high density area in 82.0% of the cases (82/100), whereas T2-weighted MR imaging showed low intensity area in 100% of the cases (32/32). Histological examination showed that most causative agents were Aspergillus species (94.2% (98/104)). Culture test was positive for 16.7% (11/66). Recurrence was found in 3.2% (3/94). Older age and female predominance were consistent with previous reports. MR imaging is recommended to confirm the diagnosis. 1. Introduction Fungal rhinosinusitis is encountered in about 10% of patients requiring surgery for diseases of the nose and sinuses, and fungal or mixed fungal and bacterial infections are responsible for 13.5% to 28.5% of all cases of maxillary sinusitis [1, 2]. Sinus fungus ball is a form of fungal sinusitis defined as noninvasive chronic fungal sinusitis without inspissated allergic mucin and occurs in immunocompetent hosts. The clinical condition now defined as ˇ°fungus ballˇ± was previously called ˇ°mycetoma,ˇ± ˇ°aspergillosis,ˇ± or ˇ°aspergilloma,ˇ± but better understanding of its pathophysiology has led to an update of terminology by recommending the use of the term ˇ°fungus ballˇ± [1, 2]. Surgical treatment with the endoscope usually results in good outcome. Several case series have been reported [2¨C6], but none in the Japanese population. Fungal infection is reported to have regional characteristics. Only 30 of 109 patients lived in urban areas with a population greater than 50,000 [5]. A study of the composition of the ambient air showed different fungus species present in France and the USA [7]. This study analyzed cases of sinus fungus ball in the Japanese population. 2. Materials and Methods We retrospectively reviewed the clinical records of patients diagnosed with sinus fungus ball who underwent surgery at the Department of Otorhinolaryngology, Jikei University Hospital, Tokyo, Japan, between April 2005 and November 2010. The diagnosis was based on histological examination of the
%U http://www.hindawi.com/journals/ijoto/2013/731640/