Classification of Fungal Sinusitis

Abstract

The classification of fungal sinusitis has gradually evolved over the past several decades. Classification is essential to choose appropriate management strategies as well as to predict prognosis. The first distinction between invasive and noninvasive sinusitis was made by Hora [1] in 1965 on the basis of clinical findings. Chronic granulomatous sinusitis was first described in Sudan in 1967, and subsequent cases were reported from Pakistan, India, and also from the USA [2–4]. In 1976, Safirstein [5] reported a combination of nasal polyposis, crusting, and Aspergillus species in sinus cultures similar to those seen in allergic bronchopulmonary aspergillosis (ABPA). In 1980, McGill [6] et al. reported a fulminant form of fungal rhinosinusitis with a malignant course in immunocompromised patients. Also, in 1980, Talbot et al. [7] presented a classification of invasive fungal sinusitis as (1) fulminant aspergillosis, (2) rhinocerebral mucormycosis, and (3) aspergilloma. In 1988, invasive sinusitis was classified as acute invasive and chronic invasive in a review of chronic sinusitis in normal hosts [4]. Meanwhile, several clinicians, individually [8–12] recognized cases of chronic rhinosinusitis associated with a mucosal plug in sinuses of patients with ABPA, and this led to the renaming of this type of fungal rhinosinusitis as allergic fungal sinusitis or rhinosinusitis (AFS or AFRS). Ponikau et al. [13] have proposed the term “eosinophilic fungal rhinosinusitis” to reflect the important feature “eosinophils.”