Types of Fungal Sinusitis

1. Fungus Ball (Mycetoma)

A non-invasive dense collection of fungal hyphae, usually in a single sinus (often maxillary). Patients usually have chronic sinus symptoms and the condition is cured by complete endoscopic removal.

2. Allergic Fungal Rhinosinusitis (AFRS)

An allergic inflammatory disease with thick allergic mucin containing fungal elements; treatment is combined surgical removal and medical (steroid) therapy.

3. Chronic Invasive Fungal Rhinosinusitis

Slowly progressive tissue invasion seen in patients with some degree of immune dysfunction; requires surgery plus prolonged antifungal therapy.

4. Acute Invasive Fungal Rhinosinusitis (AIFS)

An aggressive, life-threatening infection seen in severely immunocompromised patients (eg, uncontrolled diabetes, neutropenia) that needs urgent, often repeated endoscopic debridement together with systemic antifungals.

Symptoms & Common Causes

• Nasal obstruction and purulent nasal discharge
• Facial pain/pressure, headaches, reduced sense of smell
• Recurrent sinus infections despite antibiotics
• In AIFS: fever, facial numbness, orbital signs, rapid deterioration

Risk factors include prior sinus disease, use of topical/systemic steroids, uncontrolled diabetes, immunosuppression, and previous endodontic or dental issues (for maxillary fungus ball).

Diagnosis

Diagnosis is made by combining history, nasal endoscopy, CT imaging (showing hyperdense foci or obstructed sinuses), intraoperative findings, and histopathology/culture of fungal material. Imaging helps differentiate non-invasive from invasive disease and plan the extent of debridement.

Treatment: Endoscopic Debridement & Medical Care

Endoscopic sinus surgery with thorough debridement (removal of fungal debris, allergic mucin, and necrotic tissue) is the mainstay of treatment for most fungal sinusitis subtypes. The surgical goal is complete clearance, restoration of sinus ventilation and drainage, and obtaining tissue for definitive diagnosis.

Adjunctive Medical Treatments

• Non-invasive disease (fungus ball): usually cured by surgery alone; systemic antifungals are not routinely required.
• AFRS: postoperative topical and short-course systemic steroids, saline irrigations, and allergy management.
• Invasive disease (chronic/acute): urgent surgical debridement combined with systemic antifungal therapy and aggressive control of underlying conditions (eg, glycaemic control in diabetes).

How the Procedure Is Performed

Endoscopic debridement is done under general or local anesthesia depending on the case. Using endoscopes and microinstruments, the surgeon clears the involved sinus cavities, removes fungal collections and mucin, widens natural ostia for drainage, and obtains tissue for histology. In AIFS, debridement is often more extensive and may need repeat procedures.

Benefits & Recovery

• Minimally invasive with no external incisions and faster recovery
• Direct removal of disease burden improves symptoms and reduces need for long-term medications
• In invasive disease, early and repeated debridement improves outcomes

Postoperative care typically includes saline nasal irrigations, endoscopic cleaning in clinic, topical steroids (as indicated), and systemic antifungals only when histology/culture or disease type requires them.

Prevention & Follow-up

• Treat and control allergies and sinus inflammation
• Avoid unnecessary prolonged topical steroid use without supervision
• Manage systemic risk factors (e.g., diabetes, immunosuppression)
• Regular endoscopic follow-up to clear crusts and monitor for recurrence

Why Choose Dr. Shrekha Padmakshan?

Dr. Shrekha Padmakshan provides experienced endoscopic sinus care with careful intraoperative sampling, tailored combined medical-surgical treatment plans, and close postoperative endoscopic follow-up to minimize recurrence and protect sinus function.

• Expertise in endoscopic debridement for both non-invasive and invasive fungal sinusitis
• Multidisciplinary coordination with infectious disease, endocrinology and ophthalmology when required
• Individualized plans for antifungal therapy, allergy control, and follow-up care

If you experience persistent sinus symptoms, recurring infections, or symptoms suggestive of fungal sinusitis, book a consultation. Early evaluation, accurate diagnosis, and timely endoscopic debridement (when indicated) provide the best chance for cure and prevention of complications.