Classification of Fungal Sinusitis

  • Gauri Mankekar


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.”


Chronic Rhinosinusitis Nasal Polyposis Allergic Bronchopulmonary Aspergillosis Fungal Ball Allergic Fungal Sinusitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Hora JF. Primary aspergillosis of the paranasal sinuses and associated areas. Laryngoscope. 1965;75:768–73.PubMedCrossRefGoogle Scholar
  2. 2.
    Chakrabarti A, Sharma SC, Chander J. Epidemiology and pathogenesis of paranasal sinus mycoses. Otolaryngol Head Neck Surg. 1992;107:745–50.PubMedGoogle Scholar
  3. 3.
    Hussain S, Salahuddin N, Ahmad I, Jooma R. Rhinocerebral invasive mycosis: occurrence in immunocompetent individuals. Eur J Radiol. 1995;20:151–5.Google Scholar
  4. 4.
    Washburn RG, Kennedy DW, Begley MG, Henderson DK, Bennett JE. Chronic fungal sinusitis in apparently normal hosts. Medicine. 1988;67:231–47.Google Scholar
  5. 5.
    Safirstein B. Allergic bronchopulmonary aspergillosis with obstruction of the upper respiratory tract. Chest. 1976;70:788–90.PubMedCrossRefGoogle Scholar
  6. 6.
    McGill TJ, Simpson G, Healy GB. Fulminant aspergillosis of the nose and paranasal sinuses: a new clinical entity. Laryngoscope. 1980;90:748–54.PubMedCrossRefGoogle Scholar
  7. 7.
    Talbot GH, Huang A, Provencher M. Invasive aspergillus rhinosinusitis in patients with acute leukemia. Rev Infect Dis. 1991;13:219–32.PubMedCrossRefGoogle Scholar
  8. 8.
    Millar JN, Johnston A, Lamb D. Allergic aspergillosis of the maxillary sinuses. Thorax. 1981;36:710.Google Scholar
  9. 9.
    Katzenstein AA, Sole SR, Greenberger PA. Allergic aspergillus sinusitis: a newly recognized form of sinusitis. J Allergy Clin Immunol. 1983;72:82–93.CrossRefGoogle Scholar
  10. 10.
    Allphin AL, Strauss M, Abdul Karim FW. Allergic fungal sinusitis: problems in diagnosis and treatment. Laryngoscope. 1991;101:815–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Manning SC, Schaefer SD, Close LG, Vuitch F. Culture positive allergic fungal sinusitis. Arch Otolaryngol. 1991;117:174–8.CrossRefGoogle Scholar
  12. 12.
    Bent JP, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg. 1994;111:580–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Ponikau JU, Sherris DA, Kern EB, et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc. 1999;74:877–84.PubMedCrossRefGoogle Scholar
  14. 14.
    deShazo RD, O’Brien M, Chapin K, Sato-Aguilar M, Gardner L, Swain RE. A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surgery. 1997;123:1181–8.Google Scholar
  15. 15.
    deShazo RD, Swain RE. Diagnostic criteria for allergic fungal sinusitis. J Allergy Clin Immunol. 1995;96:24–35.PubMedCrossRefGoogle Scholar
  16. 16.
    deShazo RD, O’Brien M, Chapin K. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol. 1997;99:475–85.PubMedCrossRefGoogle Scholar
  17. 17.
    Ferguson BJ. Definitions of fungal rhinosinusitis. Otolaryngol Clin North Am. 2000;33(2):227–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Meltzer E, Hamilos D, Hadley J, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. 2004;114(Suppl):S155–22.CrossRefGoogle Scholar
  19. 19.
    Chakrabarti A, Denning DW, Ferguson B, et al. Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope. 2009;119(9):1809–18.PubMedCrossRefGoogle Scholar
  20. 20.
    Grosjean P, Weber R. Fungus balls of the paranasal sinuses: a review. Eur Arch Otorhinolaryngol. 2007;264:461–70.PubMedCrossRefGoogle Scholar
  21. 21.
    Chakrabarti A, Das A, Panda NK. Overview of fungal sinusitis- guest editorial. Indian J Otolaryngol Head Neck Surg. 2004;56(4):251–8.PubMedGoogle Scholar

Copyright information

© Springer India 2014

Authors and Affiliations

  1. 1.ENTPD Hinduja HospitalMahim, MumbaiIndia

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