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 “fungus ball” was previously called “mycetoma,” “aspergillosis,” or “aspergilloma,” but better understanding of its pathophysiology has led to an update of terminology by recommending the use of the term “fungus ball” [1, 2]. Surgical treatment with the endoscope usually results in good outcome. Several case series have been reported [2–6], 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
References
[1]
P. Grosjean and R. Weber, “Fungus balls of the paranasal sinuses: a review,” European Archives of Oto-Rhino-Laryngology, vol. 264, no. 5, pp. 461–470, 2007.
[2]
P. Nicolai, D. Lombardi, D. Tomenzoli et al., “Fungus ball of the paranasal sinuses: experience in 160 patients treated with endoscopic surgery,” Laryngoscope, vol. 119, no. 11, pp. 2275–2279, 2009.
[3]
X. Dufour, C. Kauffmann-Lacroix, J. C. Ferrie, J. M. Goujon, M. H. Rodier, and J. M. Klossek, “Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989–2002,” Medical Mycology, vol. 44, no. 1, pp. 61–67, 2006.
[4]
J. A. Ferreiro, B. A. Carlson, and D. T. Cody III, “Paranasal sinus fungus balls,” Head and Neck, vol. 19, no. 6, pp. 481–486, 1997.
[5]
J.-M. Klossek, E. Serrano, L. Péloquin, J. Percodani, J.-P. Fontanel, and J.-J. Pessey, “Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses,” Laryngoscope, vol. 107, no. 1, pp. 112–117, 1997.
[6]
J.-C. Lai, H.-S. Lee, M.-K. Chen, and Y.-L. Tsai, “Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery,” European Archives of Oto-Rhino-Laryngology, vol. 268, no. 2, pp. 227–230, 2011.
[7]
X. Dufour, C. Kauffmann-Lacroix, J.-C. Ferrie et al., “Paranasal sinus fungus ball and surgery: a review of 175 cases,” Rhinology, vol. 43, no. 1, pp. 34–39, 2005.
[8]
R. D. DeShazo, M. O'Brien, K. Chapin et al., “Criteria for the diagnosis of sinus mycetoma,” Journal of Allergy and Clinical Immunology, vol. 99, no. 4, pp. 475–485, 1997.
[9]
M. S. Schubert, “Fungal rhinosinusitis: diagnosis and therapy,” Current Allergy and Asthma Reports, vol. 1, no. 3, pp. 268–276, 2001.
[10]
M. S. Schubert, “Allergic fungal sinusitis: pathophysiology, diagnosis and management,” Medical Mycology, vol. 47, supplement 1, pp. S324–S330, 2009.
[11]
R. D. Deshazo, M. O'Brien, K. Chapin, M. Soto-Aguilar, L. Gardner, and R. Swain, “A new classification and diagnostic criteria for invasive fungal sinusitis,” Archives of Otolaryngology, vol. 123, no. 11, pp. 1181–1188, 1997.
[12]
K. Nakaya, T. Oshima, T. Kudo et al., “New treatment for invasive fungal sinusitis: three cases of chronic invasive fungal sinusitis treated with surgery and voriconazole,” Auris Nasus Larynx, vol. 37, no. 2, pp. 244–249, 2010.
[13]
B. J. Ferguson, “Fungus balls of the paranasal sinuses,” Otolaryngologic Clinics of North America, vol. 33, no. 2, pp. 389–398, 2000.
[14]
H.-J. Dhong, J.-Y. Jung, and J. H. Park, “Diagnostic accuracy in sinus fungus balls: CT scan and operative findings,” American Journal of Rhinology, vol. 14, no. 4, pp. 227–231, 2000.
[15]
R. Maroldi and P. Nicolai, Eds., Imaging in Treatment Planning For Sinonasal Diseases, Springer, Berlin, Germany, 2005.
[16]
H. Stammberger, “Endoscopic surgery for mycotic and chronic recurring sinusitis,” The Annals of Otology, Rhinology & Laryngology, vol. 119, pp. 1–11, 1985.
[17]
T.-L. Tsai, Y.-C. Guo, C.-Y. Ho, and C.-Z. Lin, “The role of ostiomeatal complex obstruction in maxillary fungus ball,” Otolaryngology, vol. 134, no. 3, pp. 494–498, 2006.
[18]
J. U. Ponikau, D. A. Sherris, E. B. Kern et al., “The diagnosis and incidence of allergic fungal sinusitis,” Mayo Clinic Proceedings, vol. 74, no. 9, pp. 877–884, 1999.
