Clinicopathologic characteristics of paranasal sinus fungus ball: retrospective, multicenter study in Korea

  • Dae Woo Kim
  • Yong Min Kim
  • Jin-Young Min
  • Jeong-Whun Kim
  • Jin-Kook Kim
  • Ji-Hun Mo
  • Jae-Min Shin
  • Kyu-Sup Cho
  • Sang Gyu Kwak
  • Seung-Heon ShinEmail author



Fungus ball (FB) is the most common type of fungal rhinosinusitis and the prevalence of FB has increased over the past 10 years. The aim of this study was to compare the clinical characteristics of Korean adult patients with FB and chronic rhinosinusitis (CRS) without FB.


We retrospectively analyzed data on 1362 patients (147 FB and 1215 CRS) who underwent endoscopic sinus surgery at nine Korean medical centers in 2005, 2010, and 2016. We evaluated the prevalence of FB and compared the clinical characteristics of FB and CRS. Medical records, computed tomography (CT) findings, atopic status, concomitant diseases, tissue, and blood eosinophil count were assessed.


The prevalence of FB was significantly higher in 2016 (15.9%) than in the other years (7.8% in 2005 and 7.5% in 2010). The FB patients were more likely to be female, older, have unilateral disease and less likely to have allergy compared to the CRS patients. The most common main complaint related to CRS and FB was nasal obstruction. CT determined that unilateral disease and maxillary sinus dominancy were common in patients with FB. The incidence of concomitant diseases was much higher in FB, with lower tissue and blood eosinophilia.


FB is commonly encountered in older women with the increased prevalence. FB had a different clinical presentation, radiological findings, and prognosis than CRS. Further studies are needed to understand the pathophysiologic mechanisms underlying the development of FB.


Fungus ball Chronic rhinosinusitis Retrospective study Multicenter study 


Author contributions

Conceptualization: all authors. Data curation: all authors. Formal analysis: SGK. Methodology: all authors. Project administration: S-HS. Writing-original draft: DWK, YMK. Review and editing: DWK, YMK, and S-HS.

Compliance with ethical standards

Conflict of interest

No potential conflict of interest relevant to this article was reported.


  1. 1.
    Ferreiro JA, Carlson BA, Cody DT 3rd (1997) Paranasal sinus fungus balls. Head Neck 19:481–486CrossRefGoogle Scholar
  2. 2.
    Park GY, Kim HY, Min JY, Dhong HJ, Chung SK (2010) Endodontic treatment: a significant risk factor for the development of maxillary fungal ball. Clin Exp Otorhinolaryngol 3:136–140CrossRefGoogle Scholar
  3. 3.
    Lee JS, Shin SY, Lee KH, Kim SW, Cho JS (2013) Change of prevalence and clinical aspects of fungal ball according to temporal difference. Eur Arch Otorhinolaryngol 270:1673–1677CrossRefGoogle Scholar
  4. 4.
    Shea KM, Truckner RT, Weber RW, Peden DB (2008) Climate change and allergic disease. J Allergy Clin Immunol 122:443–453 (quiz 454–455) CrossRefGoogle Scholar
  5. 5.
    Lee HW, Kang SH, Jang KH, Kim DS, Shin SH, Ye MK (2017) Changes in etiologies and clinical characteristics of operated unilateral sinus diseases: comparison study between 2005 and 2015. Korean J Rhinol 24:26–30CrossRefGoogle Scholar
  6. 6.
    deShazo RD, O'Brien M, Chapin K, Soto-Aquilar M, Swain R, Lyons M et al (1997) Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol 99:475–485CrossRefGoogle Scholar
  7. 7.
    Grosjean P, Weber R (2007) Fungus balls of the paranasal sinuses: a review. Eur Arch otorhinolaryngol 264:461–470CrossRefGoogle Scholar
  8. 8.
    Wani MK, Ruckenstein MJ, Parikh S (2001) Magnetic resonance imaging of the paranasal sinuses: incidental abnormalities and their relationship to patient symptoms. J Otolaryngol 30:257–262CrossRefGoogle Scholar
  9. 9.
    Ferguson BJ (2000) Fungus balls of the paranasal sinuses. Otolaryngol Clin N Am 33:389–398CrossRefGoogle Scholar
  10. 10.
    Nicolai P, Lombardi D, Tomenzoli D, Villaret AB, Piccioni M, Mensi M et al (2009) Fungus ball of the paranasal sinuses: experience in 160 patients treated with endoscopic surgery. Laryngoscope 119:2275–2279CrossRefGoogle Scholar
  11. 11.
    Lop-Gros J, Gras-Cabrerizo JR, Bothe-Gonzalez C, Montserrat-Gili JR, Sumarroca-Trouboul A, Massegur-Solench H (2016) Fungus ball of the paranasal sinuses: analysis of our series of patients. Acta Oorrinolaringol Esp 67:220–225CrossRefGoogle Scholar
  12. 12.
    Dufour X, Kauffmann-Lacroix C, Ferrie JC, Goujon JM, Rodier MH, Klossek JM (2006) Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989–2002. Med Mcol 44:61–67CrossRefGoogle Scholar
  13. 13.
    Cho JH, Jeong YS, Lee YJ, Hong SC, Yoon JH, Kim JK (2009) The Korean version of the Sniffin' stick (KVSS) test and its validity in comparison with the cross-cultural smell identification test (CC-SIT). Auris Nasus Larynx 36:280–286CrossRefGoogle Scholar
  14. 14.
    Barnes CS (2018) Impact of climate change on pollen and respiratory disease. Curr Allergy Asthma Rep 18:59CrossRefGoogle Scholar
  15. 15.
    Koo MHSY, Lee JH (2006) Analyzing spatial and temporal variation of ground surface temperature in Korea. Econ Environ Geol 39:255–268Google Scholar
  16. 16.
    Ys C (2016) Practical guideline of asthma management—Korean guideline for asthma 2015. Korean J Med 90:298–306CrossRefGoogle Scholar
  17. 17.
    Ledderose GJ, Braun T, Betz CS, Stelter K, Leunig A (2012) Functional endoscopic surgery of paranasal fungus ball: clinical outcome, patient benefit and health-related quality of life. Eur Arch Otorhinolaryngol 269:2203–2208CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Otolaryngology-Head and Neck SurgerySeoul Metropolitan Government Seoul National University Boramae Medical CenterSeoulSouth Korea
  2. 2.Department of Otolaryngology-Head and Neck Surgery, School of MedicineChungnam National UniversityDaejeonSouth Korea
  3. 3.Department of Otolaryngology-Head and Neck Surgery, School of MedicineKyung Hee UniversitySeoulSouth Korea
  4. 4.Department of Otolaryngology-Head and Neck Surgery, College of MedicineSeoul National UniversitySeoulSouth Korea
  5. 5.Department of Otolaryngology-Head and Neck Surgery, School of MedicineKonkuk UniversitySeoulSouth Korea
  6. 6.Department of Otolaryngology-Head and Neck Surgery, School of Medicine, College of MedicineDankook UniversityCheonanSouth Korea
  7. 7.Department of Otolaryngology-Head and Neck Surgery, School of MedicineKorea UniversitySeoulSouth Korea
  8. 8.Department of Otolaryngology-Head and Neck Surgery, School of MedicinePusan National UniversityBusanSouth Korea
  9. 9.Department of Medical Statistics, School of MedicineCatholic University of DaeguGyeongsanSouth Korea
  10. 10.Department of Otolaryngology-Head and Neck Surgery, School of MedicineCatholic University of DaeguDaeguSouth Korea
  11. 11.Department of OtorhinolaryngologyDaegu Catholic University Medical CenterDaeguSouth Korea

Personalised recommendations