Abstract
Fungal sphenoid sinusitis is easily misdiagnosed in clinic, particularly for patients with normal immunological status. Due to the anatomic characteristics of sphenoid sinus, patients presented with various nonspecific symptoms and complications. Headache is the most common presentation, but location of headache is not fixed. We intended to analyze 6 cases of headache secondary to the isolated sphenoid sinus fungus ball (SSFB) which were first diagnosed in the Neurology Department. There was significant female predominance with mean ages of 55 years. They had repeatedly headache history from months to years. The headache was unilateral and usually on the side of lesions. Medication of pain relievers worked well in the beginning of SSFB, but not in the late stage of disease. Notably, all patients did not present positive nervous systemic signs. A preoperative computed tomography (CT) scan or magnetic resonance imaging (MRI) demonstrated the inflammation in sphenoid sinus. Some cases showed calcification in soft tissue or bone lesions of sinus wall. All of 6 patients undertook transnasal endoscopic sphenoidotomy without antifungal therapy after operation. Characteristic fungus ball (FB) was detected after histopathological examination. No headache recurrence was found after average 15.5 months follow-up. Our results suggested that transnasal endoscopic sphenoidotomy is the treatment of choice to remove the FB in sphenoid sinus with a low rate of morbidity and recurrence.
Highlights
Fungal rhinosinusitis can be broadly classified as invasive and noninvasive fungal infection according to histopathology
All of the 6 patients were treated by transnasal endoscopic sphenoidotomy without antifungal therapy, and histopathology diagnosis was isolated sphenoid sinus fungus ball (SSFB)
Our results suggested that SSFB should be considered in patients with unexplained headache, especially in elderly women
Summary
Fungal rhinosinusitis can be broadly classified as invasive and noninvasive fungal infection according to histopathology. The pathological features of noninvasive fungal rhinosinusitis are fungal infection confined to the paranasal sinuses, mucous membrane, and bone wall without fungal invasion, including fungus ball (FB) and allergic fungal rhinosinusitis [1, 2]. We sought to retrospectively analyze on how effectively diagnose and treat of 6 sphenoid sinus fungus ball patients in our institution. Lesion was found in the right sphenoid sinus. This patient was immediately hospitalized in the Otolaryngology Department. Further paranasal sinus CT demonstrated abnormal density of the right sphenoid sinus with calcification and lesion on the sinus wall (Figure 1). Histopathological examination diagnosed right sphenoid sinus as SSFB (Figure 2). No further recurrence of her headache was found after 14 months follow-up
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
