Analysis of clinical characteristics of fungal ball in unilateral maxillary sinus

Abstract

Objective:The aim of this study is to investigate the pathological characteristics of unilateralmaxillary sinus fungus ball（UMFB） in order to improve the accuracy of clinical diagnosis. Methods:A total of 86 patients with unilateral maxillary sinus lesions who underwent nasal endoscopic surgery in Qilu Hospital of Shandong University（Qingdao） from January 2017 to June 2019 were included. Those patients were confirmed UMFB or unilateral chronic maxillary sinusitis（UCMS） by pathology. The characteristics including age, sex, diabetes mellitus or no, CT features of the diseased maxillary sinus and GOSS osteitis score of the posterolateral wall of the maxillary sinus were analyzed, and the differences between the two groups were compared. CT features include: ①intralesional hyperdensity（calcification）; ②maxillary sinus full haziness with or without mass effect; ③the irregular lobulated protruding lesion（fuzzy appearance） or smooth. Chi-square, independent sample t test and Mann-Whitney U test were performed. Logistic regression analysis and receiver operating Characteristic（ROC） curve analysis were used to find the best cutoff value for UMFB diagnosis. Results:Among the 86 cases of unilateral maxillary sinus lesions, 62 cases were UMFB, which accounted for 72.1%, and 24 cases were UCMS, which accounted for 27.9%. UMFB usually occurs in middle-aged and elderly patients, and there are more females than males. There was no statistical difference between the two groups with or without diabetes. In terms of CT characteristics of paranasal sinuses, intergroup comparison and binary Logistic regression analysis, intralesional hyperdensity, maxillary sinus full haziness with mass effect, the irregular lobulated protruding lesion（fuzzy appearance） were significant predictors of MFB（all P<0.05）. The score of osteitis in UMFB was significantly higher than that in UCMS（P<0.001）. ROC curve analysis showed that when the cutoff value was more than 3.5（the area under the curve was 0.824）, the corresponding sensitivity and specificity were 0.516 and 0.958, respectively. Conclusion:The age, gender, CT characteristics and maxillary sinus osteitis score can distinguish UMFB from unilateral maxillary sinus chronic inflammation, and improve the accuracy of clinical diagnosis.