Comparison of the clinical characteristics of bilateral and unilateral fungal balls in Korea

  • Sang Hyeon Ahn
  • Eun Jung Lee
  • Min Pyo Hong
  • Geun Cheol Shin
  • Kyung-Su KimEmail author



Fungal rhinosinusitis occurs in different forms depending on race and region. While allergic fungal rhinosinusitis is common in Caucasians, fungal ball (FB) is more common in Asians. However, most cases are reported as unilateral, and clinical data on bilateral FB (BFB) are rare. Therefore, the purpose of this study was to analyze and to compare the clinical characteristics of BFB and unilateral FB (UFB) in Koreans.


We retrospectively analyzed medical records and computed tomography (CT) images of 434 patients diagnosed with FB. The patients were divided into two groups: BFB and UFB. Demographic data, multiple allergen simultaneous test including total or specific immunoglobulin E (IgE) levels, symptoms, CT findings, treatment, and outcomes were analyzed.


Among the patients, 26 had BFB and 408 had UFB. Hypertension was noted in 61.5% of the BFB and 39% of the UBF individuals (p = 0.023). While total IgE levels were similar between the two groups, Dermatophagoides pteronyssinus (p = 0.004), Cladosporium (p = 0.017), and Aspergillus-specific IgE positivity (p = 0.025) were significantly higher in the BFB than in the UFB group. Not only symptoms such as postnasal drip (p = 0.013), mucopurulent rhinorrhea (p = 0.009), and foul odor (p = 0.037), but also sphenoid sinus involvement on CT images were more common in the BFB than in the UFB group (p = 0.011).


Patients with BFB in Korea showed more common hypertension and symptoms of foul odor, mucopurulent rhinorrhea, and postnasal drip with allergy positivity compared to those with UFB. Therefore, understanding clinical characteristics of BFB will allow clinicians to approach BFB more appropriately.


Fungal rhinosinusitis Bilateral Fungal ball Aspergillus Korea 




Author contribution

SHA: study concept and design, drafting of manuscript, manuscript revision. EJL: interpretation of data, revision of manuscript, MPH and GCS: collecting data, KSK: study concept and design, revision of manuscript, interpretation of data, approval of final version of manuscript to be published.



Compliance with ethical standards

Conflict of interest

All authors declared no conflicts of interest.

Informed consent and ethics committee review approval

This study was reviewed and approved by the Institutional Review Board (IRB). The study was also conducted in accordance with the ethical standards of the institutional and/or national research committee, 1964 Helsinki Declaration and subsequent amendments, or similar ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sang Hyeon Ahn
    • 1
    • 2
  • Eun Jung Lee
    • 3
    • 4
  • Min Pyo Hong
    • 3
  • Geun Cheol Shin
    • 3
  • Kyung-Su Kim
    • 3
    Email author
  1. 1.Department of OtorhinolaryngologyBundang Jesaeng General Hospital, Daejin Medical CenterSeongnamKorea
  2. 2.Department of MedicineThe Graduate School of Yonsei UniversitySeoulKorea
  3. 3.Department of Otorhinolaryngology, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
  4. 4.Department of Clinical and Experimental MedicineThe Centre for Personalised MedicineLinköpingSweden

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