Diagnostic Accuracy of Maxillary Sinus Wall Thickness in Sinus Fungus Balls

Abstract

BACKGROUND: Fungus balls, or mycetoma is common kind of maxillary sinus infection. Complete removal of the fungus balls from the sinus is important in single stage sinus surgery. We hoped to identify some specific symptoms and signs before surgery and evaluate the diagnostic accuracy of a computed tomography (CT) scan of the fungus balls in patients with maxillary fungal sinusitis before surgery. METHODS: A retrospective review of twenty-six patients with isolated maxillary sinus lesions and confirmative diagnosis of aspergillosis from 2002 to 2007 was done, including a detailed chart review for symptoms and pre-operative sinuscopic findings. We estimated the thickening of the involved sinus bony walls anteriorly and posterolaterally. At the same time, we also recorded the presence of calcification or not inside the sinus. RESULTS: The thickening of maxillary sinus bony wall was statistically significant either in the posterolateral or anterior wall in the CT scan (paired t-test, p ＜ 0.05). Half of these patients had calcified foci inside the sinus. No specific findings were noted in pre-operative sinuscopic examinations. CONCLUSIONS: Precise diagnosis of fungus balls for isolated sinus disease is important before sinus surgery. Thickening of the sinus wall, not only posterolaterally but also anteriorly, is a pathognomonic sign for fungus balls in isolated maxillary sinusitis.