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Fungal Sinusitis- Causes, Types, Diagnosis and Treatment

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Fungal sinusitis is the term used to refer to the inflammation of the lining of the sinuses due to a fungal infection. Scroll down to read more.

Medically reviewed by

Dr. Pandian. P

Published At January 12, 2023
Reviewed AtDecember 29, 2023

What Is Fungal Sinusitis?

Fungal sinusitis is a group of infections affecting the sinus caused by fungus. Most fungal infections cause similar symptoms, such as nasal congestion and pain in the cheeks, forehead, and between the eyes, which is known as sinus pain. People with other conditions which make them immunocompromised are the ones who are more prone to such infections. Fungal sinusitis can affect normally healthy people also, but this condition does not cause as many complications as in immunocompromised patients. This can show the invasive nature of immunocompromised patients. It is important to identify the invasive and non-invasive types of infections as the treatment and prognosis are different for both. Some of these infections in immunocompetent patients can damage the lining of the nose and invade the brain and cause the death of the patient.

What Are the Sinuses?

Sinuses are the hollow air-filled spaces present inside the skull. They are located across the forehead, behind the nose, in between the eyes, and under the cheekbones. There is a mucus membrane covering the inner wall of the sinus, which traps the bacteria and keeps the air inside the sinus moist. There should be proper drainage from the sinus; when the drainage is blocked, it will cause some problems.

What Are the Types of Fungal Sinusitis?

Fungal infections can be classified into invasive and non-invasive types. The invasive types are the ones that spread to the other parts of the body, like the brain and eyes. The non-invasive types are the ones that do not spread and remain confined to the sinus and nose. Non-invasive ones are the more commonly seen types of fungal infections.

The types of non-invasive fungal infections are:

  • Allergic Fungal Rhinosinusitis- This is the most common type affecting the nose and the sinus. This is caused due to an allergic reaction to the fungi inside the nose. If left untreated, the sinus can get filled with thick mucus and may result in the formation of nasal polyps. This condition is more likely to develop in people with asthma or allergic rhinitis.

  • Saprophytic Fungal Sinusitis- This type of fungus grows on the mucus crust inside the nose; hence they do not affect the nose directly, and when the crust is removed from the nose, the fungus is also eliminated from the body.

  • Fungal Ball (Mycetoma)- The fungal develops inside the sinus in a ball shape and hence the name fungal ball. When the fungal ball grows in size, it can block the sinus. Hence surgery must be performed to remove the ball and clean the sinus.

When the invasive type of fungal sinusitis is left untreated it can be life-threatening. The different types of invasive fungal sinusitis are:

  • Acute Fulminant Invasive Rhinosinusitis- This type of fungal sinusitis is more common in patients who have cancer, chemotherapy, or organ transplant and they are immunocompromised. They cause the death of the tissue inside the nose by cutting the blood supply to that area. This infection spreads easily to the eyes and brain, leading to blindness and death.

  • Chronic Invasive Rhinosinusitis- They are most likely to affect diabetes patients, and they are similar to acute fulminant invasive rhinosinusitis, but they do not spread as fast.

  • Granulomatous Invasive Fungal Sinusitis (GIFS)- This is a rare type of fungal infection and happens when the body's immune response reacts to the fungal infection. The body's immune response attacks the lining of the nose, which destroys them.

What Are the Symptoms of Fungal Sinusitis?

The symptoms of fungal sinusitis include:

  • Altered sense of smell.

  • Fever.

  • Inflammation in the nose and the sinus.

  • Nasal congestion.

  • Discharge from the nose.

  • Sinus pain.

  • Tenderness in the sinus region and feeling of pressure inside the sinus.

People with compromised immunity have more serious complications, such as:

  • The trouble with thinking and behavioral problems.

  • Skin color may turn black or pale.

  • Numbness in the face.

  • Proptosis (eyeball protruding from the eye socket).

  • Changes in vision like loss of vision and blurred vision.

  • Severe swelling in the cheek region.

What Causes Fungal Sinusitis?

Fungal sinusitis is caused by a group of organisms called fungi. There are different types of fungi, but most fungal sinusitis infection is caused by yeast or mold that enter the nose while breathing. Also, there are many types that are already present inside our body but they become problematic only in immunocompromised conditions.

How to Diagnose Fungal Sinusitis?

The healthcare provider will ask for the symptoms, health history, and other medications taken. They will also do physical check-ups.

  • To diagnose the condition, they will take samples from the nose and sinus, like mucus or the lining tissue, and send them to the lab for further investigation.

  • Other imaging techniques such as CT (computed tomography) scans or X-rays may also be advised to see detailed images of the sinuses. It will help the doctor identify the sinus infection and also to look for the fungal balls, which will help them deliver an effective treatment.

  • An endoscopy may also be advised to further evaluate the status of the infection and the condition of the sinus and the nose.

What Is the Treatment for Fungal Sinusitis?

The treatment for fungal sinusitis varies from person to person. Some of these might not require any treatment in a healthy individual, whereas, in the case of an immunocompromised patient, they require immediate medical attention.

The treatments include:

  • Antifungal Medications- Some of these infections need treatment with antifungal medicines.

  • Corticosteroids- Corticosteroids are prescribed in order to reduce inflammation and relieve sinus pain due to pressure building in the sinus.

  • Nasal Wash- To remove the crust of mucus and wash the sinus, the doctors will prescribe nasal wash. They are saline solutions used to clean the sinuses.

  • Surgery- In some cases, surgery might be required to remove the infection either by the traditional method of surgery or by minimally invasive endoscopic surgery.

Conclusion

Fungal sinusitis is not a very serious infection, and it will resolve on its own in most patients. But for immunocompromised patients, this condition can be fatal and requires immediate medical attention. If notice any symptoms of sinus infection, consult the doctor, as they can determine the cause and deliver the best treatment. If an individual is taking immunosuppressant medications or has any immunocompromising condition and observes these symptoms seek medical attention right away.

Frequently Asked Questions

1.

How Is Fungal Sinusitis Managed?

Sinus infections that result from fungus are referred to as fungal sinusitis. Treatment methods vary among individuals, as healthy individuals might not require any treatment. However, immunocompromised patients with fungal sinusitis can be treated with antifungal medications such as Amphotericin B, azole antifungals, corticosteroids, or surgical debridement. Fungal immunotherapy is also recommended in some patients to reduce corticosteroid needs.

2.

What Are the Causes of Fungal Sinusitis?

Fungal sinusitis usually results from mold or yeast, and these microorganisms can enter the sinus through the nose during breathing. The most common cause of allergic and invasive sinusitis is Aspergillus, Mucor, and Rhizopus organisms. Fungal sinus infections cause symptoms such as nasal congestion and pain in the forehead, eyes, cheeks, etc.

3.

What Are Some of the Natural Remedies for Fungal Sinusitis?

Some of the natural remedies for fungal sinusitis include;
- Steam therapy by taking a hot shower or inhaling hot water vapors.
- Nasal irrigation can be done by salt water mixture to clear the mucus.
- Applying a warm compress to the face relieves pain and pressure.
- A humidifier provides moisture to the air and helps clear congestion.

4.

How Is Fungal Sinusitis Diagnosed?

The doctor can diagnose sinusitis by a physical examination and the signs and symptoms such as headache, congestion, fever, swelling of the eyes, dizziness, vertigo, diplopia (double vision), etc. Lab and imaging tests such as endoscopy, X-rays, and computed tomography (CT scan) can help confirm the diagnosis.

5.

What Is Invasive Fungal Sinusitis?

Invasive fungal sinusitis is a severe infection that begins in the sinus and spreads quickly to the eyes, blood vessels, and central nervous system. It can be acute or chronic. Chronic fungal sinusitis spreads slowly and is usually mistaken for a sinus infection, whereas acute fungal sinusitis is an emergency and must be treated immediately.

6.

How Common Is Fungal Sinusitis?

Fungal sinusitis is a rare infection that often affects immunocompromised people. However, it can also occur in immunocompetent people. Research suggests a prevalence of fungal sinusitis in patients with immunodeficiency secondary to cancer therapy, post-transplantation procedures, diabetes mellitus, and increased use of medications such as antibiotics and immunosuppressants

7.

Is Fungal Sinusitis a Medical Emergency?

Acute invasive fungal sinusitis is a medical emergency and can be life-threatening. It is characterized by symptoms such as changes in vision, facial pain, swelling, numbness, change in mental status, fever, headache, etc. It is usually managed by surgical intervention by removal of the infected tissue through a minimally invasive procedure through the endonasal approach (nasal passages).

8.

What is Allergic Fungal Sinusitis?

Allergic fungal sinusitis (AFS) is a common fungal infection of the sinus which occurs through the infecting fungi in the environment. It causes an allergic reaction which leads to sticky mucus, thick fungal debris, and blockage in the infected sinus. Patients may also have nasal polyps and asthma, affecting their perception of smell. It is commonly seen in young adults and adolescents but can occur at any age.

9.

How Is the Nasal Discharge in Fungal Sinusitis?

Fungal sinusitis is associated with nasal congestion, headache, decreased sense of smell, pain, and inflammation of the nose and the sinuses. Mucus secretions are usually thick and sticky and have a characteristic yellow color and rubber cement consistency. The secretions contain degranulated eosinophil proteins and fungal elements.

10.

Can Thyme Oil Be Used to Treat Fungal Sinusitis?

Essential oils are odorous products obtained from botanically defined plant raw material by steam or dry distillation without heating. Thyme oil is an essential oil that is effective against fungi infecting humans. Studies demonstrate that molds such as Aspergillus, Candida, Cladosporium, and Penicillium species could be wholly inhibited using different thyme oil concentrations.

11.

How Is Allergic Fungal Sinusitis Managed?

Surgical removal of the mucus and thick fungal debris is the most effective way of managing allergic fungal sinusitis (AFS). Steroids are prescribed before and after the surgery. Treatment modalities such as immunotherapy or anti-inflammatory therapy can also eliminate the fungal colonies. The recurrence of AFS in some patients may require additional surgeries.
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Dr. Pandian. P
Dr. Pandian. P

General Surgery

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