Fungal Sinusitis

Sinuses The sinuses are cavities located within the skull around the nose, under the bones of the cheeks and forehead. Two distinct types of Aspergillus sinusitis exist, both in people who have healthy immune systems:

 

Allergic Fungal Rhinosinusitis

Symptoms are nasal airways obstruction (difficulty breathing through the nose), allergic nasal congestion (blockage as a result of being exposed to something the person is allergic to), purulent rhinorrhoea (thick green 'snot'), postnasal drainage (mucus dripping down the back of the throat from the back of the nose) and headaches. Pain is not usual but if present tends to indicate an additional bacterial infection of the sinuses. This infection is usually diagnosed using blood tests (to detect antibodies to the fungus), CT scan (see 'Pictures of Nasal polyps' on the right side of this page), endoscopy and culture of samples taken from the sinus. Nasal polyposis is often present (N.B. these are NOT cancerous even though they are described as tumours). This condition is usually treated with steroids and surgery. The steroids are usually continued for some time as reduction of inflammation inside the nasal passages and sinuses is important to allow natural drainage. Once drainage is optimised the inflammation usually subsides and eventually steroids can be slowly stopped.

Prognosis

Despite all these efforts patients relapse quite frequently and some doctors have tried treating with antifungal medication to try to eradicate the fungus but results are confused so far - this is a subject for more research. 
In exceptional cases the bones of the sinus can be perforated, allowing the fungus to invade neighbouring sites such as the eye.

 

Saprophytic Sinusitis

Sinusitis is defined as inflammation of the paranasal sinuses, with or without infection (Wiki). Inflammation can be caused by bacterial infection, allergy, virus and fungal infection. Frequently fungal infection is detected once the condition fails to respond to antibiotics designed to kill bacterial infections but which have no effect on fungal infections. Aspergillus sinusitis is thought to be caused by repeated bacterial infections causing swelling which restricts the normal drainage of the sinus. Treatment with antibiotics thus often produces a partial response as the bacteria die away and the swelling reduces and this must lead to many incomplete diagnoses. Symptoms are nasal congestion, facial discomfort, headache and postnasal drainage. Diagnosis is by CT scan or endoscopy (a tiny camera inserted into the sinuses - see a short movie here) or quite frequently during surgery to improve drainage! Treatment is by surgery to improve sinus drainage - a major contributing factor to getting the problem in the first place is a slightly different structure to the sinus which makes drainage less easy. Surgery corrects that fault. Antifungals are not normally used.

Prognosis

Sinusitis can be prone to reoccurrence but this is usually a successful procedure.

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Further information

Allergic Fungal Rhinosinusitis (AFRS) by Professor Arunaloke Chakrabarti. A full review of this illness on the Aspergillus Website Treatment Section

Pictures of Nasal polyps presented by an Otolaryngology website based in Houston, Texas. An illustration and explanation of nasal polyposis.

Pictures of sinus aspergillosis in the Image Library at the Aspergillus Website (Free registration required).

Sinuses and sinusitis - a guide by the American Academy of Allergy Asthma & Immunology.

We have two short movies that show examples of sinusitis being examined and cleaned via an endoscope - a small camera and several tools at the end of a long flexible tube:

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