Fungal sinusitis among patients with chronic rhinosinusitis who underwent endoscopic sinus surgery

Introduction: Fungal paranasal sinusitis can be either invasive or noninvasive. Saprophytic infections, fungus balls (FB) and allergic fungal rhinosinusitis are noninvasive (AFR). Materials and methods: The present study examined 521 patients who underwent endoscopic sinus surgery between January 2016 and April 2017 due to chronic paranasal sinusitis at the Department of Laryngology and Laryngological Oncology of the Upper Silesian Medical Centre in Katowice. The aim of the study was to analyze histopathological and microbiological material collected intraoperatively and to determine incidence and type of fungal infections among patients treated for chronic sinusitis. Results: Chronic fungal sinusitis was confirmed in 10 of 521 operated patients. The study group consisted of 9 females and 1 male. Histopathological examination revealed dead mycelium in 5 patients and colonies of Aspergillus spp. in 4, while microbiological examination revealed Candida albicans infection in 1 case. Allergy to inhalant allergens of fungal spores of Alternaria and Penicillium was confirmed in a 73-year-old patient, which, based on the whole clinical presentation, enabled to diagnose chronic allergic fungal sinusitis. The most common location of mycelium was maxillary sinus, followed by sphenoid sinus. Discussion: The most common form of noninvansive fungal sinusitis is the so-called fungus ball, which was also confirmed in our report (95% of the test subjects). AFRS is more likely to occur in warm, moist climates that favor the growth of fungi.