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Noninvasive Fungal Sinusitis

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Infections of the Ears, Nose, Throat, and Sinuses

Abstract

The severity of fungal rhinosinusitis ranges from benign fungal balls to life-threatening acute invasive fungal sinusitis. Fortunately, the most commonly encountered forms of fungal rhinosinusitis are on the benign end of the spectrum: fungal balls and allergic fungal rhinosinusitis (AFRS). While fungal balls and AFRS share a common feature— fungus—the pathophysiology, management, and outcomes are considerably different. This chapter reviews these two types of noninvasive fungal rhinosinusitis, with an emphasis on pathophysiology and clinical management.

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References

  1. Hora JF. Primary aspergillosis of the paranasal sinuses and associated areas. Laryngoscope. 1965;75:768–73.

    Article  PubMed  CAS  Google Scholar 

  2. Ferreiro JA, Carlson BA, Cody DT III. Paranasal sinus fungus balls. Head Neck. 1997;19(6):481–6.

    Article  PubMed  CAS  Google Scholar 

  3. Dufour X, Kauffmann-Lacroix C, Ferrie JC, Goujon JM, Rodier MH, Klossek JM. 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 Mycol. 2006;44(1):61–7.

    Article  PubMed  CAS  Google Scholar 

  4. Nicolai P, Lombardi D, Tomenzoli D, et al. Fungus ball of the paranasal sinuses: experience in 160 patients treated with endoscopic surgery. Laryngoscope. 2009;119(11):2275–9.

    Article  PubMed  Google Scholar 

  5. Klossek JM, Serrano E, Peloquin L, et al. Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses. Laryngoscope. 1997;107(1):112–7.

    Article  PubMed  CAS  Google Scholar 

  6. Jiang RS, Hsu CY. Serum immunoglobulins and IgG subclass levels in sinus mycetoma. Otolaryngol Head Neck Surg. 2004;130(5):563–6.

    Article  PubMed  Google Scholar 

  7. Mensi M, Piccioni M, Marsili F, Nicolai P, Sapelli PL, Latronico N. Risk of maxillary fungus ball in patients with endodontic treatment on maxillary teeth: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(3):433–6.

    Article  PubMed  Google Scholar 

  8. Nicolai P, Mensi M, Marsili F, et al. Maxillary fungus ball: zinc-oxide endodontic materials as a risk factor. Acta Otorhinolaryngol Ital. 2015;35(2):93–6.

    PubMed  PubMed Central  CAS  Google Scholar 

  9. Ponikau JU, Sherris DA, Kern EB, Homburger HA, Frigas E, Gaffey TA, et al. The diagnosis and incidence of allergic fungal sinusitis. May Clin Proceed. 1999;74(9):877–84.

    Article  CAS  Google Scholar 

  10. Aribandi M, McCoy VA, Bazan C. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radio Graphics. 2007;27:1283–96.

    Google Scholar 

  11. Montone KT, Livolsi VA, Feldman MD, et al. Fungal rhinosinusitis: a retrospective microbiologic and pathologic review of 400 patients at a single university medical center. Int J Otolaryngol. 2012;2012:684835.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Granville L, Chirala M, Cernoch P, Ostrowski M, Truong LD. Fungal sinusitis: histologic spectrum and correlation with culture. Hum Pathol. 2004;35:474–81.

    Article  PubMed  Google Scholar 

  13. Ence BK, Gourley DS, Jorgensen NL, Shagets FW, Parsons DS. Allergic fungal sinusitis. Am J Rhinol. 1990;4:169–78.

    Article  Google Scholar 

  14. Marple BF. Allergic fungal rhinosinusitis: current theories and management strategies. Laryngoscope. 2001;111(6):1006–19.

    Article  PubMed  CAS  Google Scholar 

  15. Lu-Myers Y, Deal AM, Miller JD, Thorp BD, Sreenath SB, McClurg S, et al. Comparison of socioeconomic and demographic factors in patients with chronic rhinosinusitis and allergic fungal sinusitis. Otolaryngol Head Neck Surg. 2015;153:137–43.

    Article  PubMed  Google Scholar 

  16. Ferguson BJ, Barnes L, Bernstein JM, et al. Geographic variation in allergic fungal rhinosinusitis. Otolaryngol Clin North Am. 2000;33(2):441–9.

    Article  PubMed  CAS  Google Scholar 

  17. Saravanan K, Panda NK, Chakrabarti A, Das A, Bapuraj RJ. Allergic fungal rhinosinusitis: an attempt to resolve the diagnostic dilemma. Arch Otolaryngol Head Neck Surg. 2006;132:173–8.

    Article  PubMed  Google Scholar 

  18. deShazo RD, Swain RE. Diagnostic criteria for allergic fungal sinusitis. J Allergy Clin Immunol. 1995;96:24–35.

    Article  PubMed  CAS  Google Scholar 

  19. Ferguson BJ. Definitions of fungal rhinosinusitis. Otolaryngol Clin North Am. 2000;33(2):227–35.

    Article  PubMed  CAS  Google Scholar 

  20. Hutcheson PS, Schubert MS, Slavin RG. Distinctions between allergic fungal rhinosinusitis and chronic rhinosinusitis. Am J Rhinol Allergy. 2010;24:405–8.

    Article  PubMed  Google Scholar 

  21. Manning SC, Holman M. Further evidence for allergic pathophysiology in allergic fungal sinusitis. Laryngoscope. 1998;108(10):1485–96.

    Article  PubMed  CAS  Google Scholar 

  22. Chang YT, Fang SY. Tissue-specific immunoglobulin E in maxillary sinus mucosa of allergic fungal sinusitis. Rhinology. 2008;46:226–30.

    PubMed  Google Scholar 

  23. Wise SK, Ahn CN, Lathers DM, Mulligan RM, Schlosser RJ. Antigen-specific IgE in sinus mucosa of allergic fungal rhinosinusitis patients. Am J Rhinol. 2008;22:451–6.

    Article  PubMed  Google Scholar 

  24. Collins M, Nair S, Smith W, Kette F, Gillis D, Wormald PJ. Role of local immunoglobulin E production in the pathophysiology of noninvasive fungal sinusitis. Laryngoscope. 2004;114:1242–6.

    Article  PubMed  CAS  Google Scholar 

  25. Ragab A, Samak RM. Immunohistochemical dissimilarity between allergic fungal and nonfungal chronic rhinosinusitis. Am J Rhinol Allergy. 2013;27:168–76.

    Article  PubMed  Google Scholar 

  26. MacKenzie JR, Mattes J, Dent LA, Foster PS. Eosinophils promote allergic disease of the lung by regulating CD4 Th2 lymphocyte function. J Immunol. 2001;167:3146–55.

    Article  PubMed  CAS  Google Scholar 

  27. Garro AP, Chiapello LS, Baronetti JL, Masih DT. Rat eosinophils stimulate the expansion of Cryptococcus neoformans-specific CD4() and CD8() T cells with a T-helper 1 profile. Immunology. 2011;132:174–87.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Pezato R, Balsalobre L, Lima M, Bezerra TF, Voegels RL, Gregorio LC, et al. Convergence of two major pathophysiologic mechanisms in nasal polyposis: immune response to Staphylococcus aureus and airway remodeling. J Otolaryngol Head Neck Surg. 2013;42:27.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bachert C, Gevaert P, Holtappels G, Johansson SG, van Cauwenberge P. Total and specific IgE in nasal polyps is related to local eosinophilic inflammation. J Allergy Clin Immunol. 2001;107:607–14.

    Article  PubMed  CAS  Google Scholar 

  30. Clark DW, Wenaas A, Luong A, Citardi MJ, Fakhri S. Staphylococcus aureus prevalence in allergic fungal rhinosinusitis vs other subsets of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2013;3:89–93.

    Article  PubMed  Google Scholar 

  31. Bent JP III, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg. 1994;111(5):580–8.

    Article  PubMed  Google Scholar 

  32. Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF, Nicklas RA, et al. American Academy of Allergy, Asthma and Immunology; American Academy of Otolaryngologic Allergy; American Academy of Otolaryngology-Head and Neck Surgery; American College of Allergy, Asthma and Immunology; American Rhinologic Society. Rhinosinusitis: establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg. 2004;131(6, Suppl):S1–S62.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Patro SK, Verma RK, Panda NK, Chakrabarti A, Singh P. Efficacy of preoperative itraconazole in allergic fungal rhinosinusitis. Am J Rhinol Allergy. 2015;29:299–304.

    Article  PubMed  Google Scholar 

  34. Rains BM III, Mineck CW. Treatment of allergic fungal sinusitis with high-dose itraconazole. Am J Rhinol. 2003;12:1–8.

    Article  Google Scholar 

  35. Sieberling K, Wormald PJ. The role of itraconazole in recalcitrant fungal sinusitis. Am J Rhinol Allergy. 2009;23:303–6.

    Article  Google Scholar 

  36. Panda NK, Francis AA, Chakrabarti A, Virk RS. Oral itraconazole as an adjunct to steroids in AFRS. Otolaryngol Head Neck Surg. 2012;147:114.

    Article  Google Scholar 

  37. Folker RJ, Marple BF, Mabry RL, Mabry CS. Treatment of allergic fungal sinusitis: a comparison trial of postoperative immunotherapy with specific fungal antigens. Laryngoscope. 1998;108(11 Pt 1):1623–7.

    Article  PubMed  CAS  Google Scholar 

  38. Marple B, Newcomer M, Schwade N, Mabry R. Natural history of allergic fungal rhinosinusitis: a 4- to 10-year follow-up. Otolaryngol Head Neck Surg. 2002;127(5):361–6.

    Article  PubMed  Google Scholar 

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Correspondence to Matthew W. Ryan .

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Halderman, A.A., Ryan, M.W. (2018). Noninvasive Fungal Sinusitis. In: Durand, M., Deschler, D. (eds) Infections of the Ears, Nose, Throat, and Sinuses. Springer, Cham. https://doi.org/10.1007/978-3-319-74835-1_14

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  • DOI: https://doi.org/10.1007/978-3-319-74835-1_14

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