Allergic Fungal Sinusitis



The symptoms of Allergic Fungal Sinusitis are almost identical to those of chronic sinusitis. As a result, misdiagnosis is fairly common.


Indications of Fungal Sinusitis Infection:

  • Thick greenish black or brown nasal discharge with the consistency of peanut butter mixed with sand.
  • Immune deficiency related disease.
  • Asthma.
  • Chronic allergy problems.

If fungal disease is suspected, analysis of the discharge may reveal the presence of certain fungi. However, these tests are costly and they occasionally return false negative results.

The only way to tell whether a person has noninvasive fungal sinusitis as opposed to less problematic invasion of fungus that occurs in most types of sinus, is to identify the specific microorganism causing the problem.

To do this, a small amount of puss is drained directly from the infected sinus for pathological analysis.

Once common bacterial sinusitis has been eliminated the patient almost certainly has non-invasive fungal disease. 

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Treatment

The thick greenish black or brown allergic mucin mentioned above, in conjunction with nasal polyps, may form partially calcified obstructions known as "fungus balls." 

Surgical removal of nasal polyps, fungus balls and all allergic mucin is mandatory.

If the obstruction is accessible it is usually removed in a non-invasive procedure using a thin mechanical suction device called a "microdebrider". If not, non-invasive Endoscopic sinus surgery (FESS, ESS) surgical procedure must be carried out. 

The following videos show both procedures:






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Long-term follow-up includes the use of nasal corticosteroids, together with regular endoscopic examination and outpatient debridement if necessary.

Regular consumption of 2 to 4 ounces of Mangosteen juice is recommended.

On rare occasions, the fungi will invade nasal tissue or bone and become Invasive Fungal Sinusitis. If this happens, aggressive debridement and anti-fungal treatment is essential.

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References

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