Aspergilloma Research Articles

Sinonasal Mass in the Setting of Prior Maxillofacial Surgery and Solid Organ Malignancy

Fungal rhinosinusitis (FRS) can be classified into invasive and non-invasive forms, with the fungal ball (FB) representing a common non-invasive type with generally favorable outcomes post-operatively. The clinical presentation of FB can vary and be non-specific, and it is important to consider a wide differential diagnosis for sinonasal masses, including malignancy. We present the case of a 74-year-old female presenting with a two-year history of nasal obstruction and drainage. She has a history of breast cancer and prior maxillomandibular surgery, and imaging showed a poorly defined mass in the right maxillary sinus with possible hemorrhagic and/or proteinaceous content. Rigid nasal endoscopy revealed a friable mass, and endoscopic sinus surgery findings were consistent with FB. This case exemplifies the need to consider a broad set of differential diagnoses when evaluating sinonasal masses, especially if the patient has a prior malignancy or maxillomandibular surgical history, including FB and metastases to the paranasal sinuses. Given the presence of non-specific symptoms, it is important to consider early imaging for patients with distorted anatomy and a history of malignancy. Endoscopic sinus surgery, with high success rates, is the gold-standard treatment for FB.

The Ayurvedic Management of Fungal Sinusitis in Standalone Settings: A Case Report.

A 42-year-old female with left nasal blockage, facial numbness, upper palate pain, and headache was diagnosed with fungal ball sinusitis via CT scan. Refusing surgery, she opted for Ayurveda. Comprehensive treatment led to complete symptom resolution and a clear CT scan at 3 months.

Clinicopathological and microbiological study of fungal rhinosinusitis treated with endoscopic surgery.

The objective of this study was to analyse the aetiology, clinical presentations, histopathology and microbiological aspects of fungal rhinosinusitis (FRS) in patients undergoing endoscopic surgery. The descriptive study was carried out over a 4-year period in two Serbian ENT Clinics and included patients with sinonasal pathology who underwent endoscopic surgery. The study included 26 patients. The most common forms of FRS treated by endoscopic sinus surgery was allergic FRS (AFRS). The fungus identification rate varied between entities, and was 72.2% in AFRS and 33.3% in fungal ball specimens. The common species seen in AFRS isolates were Cladosporium spp. (38.5% of isolated) and dematiaceous molds in the same percentage, while the remainder of the cultures were hyaline moulds. CT scan can be very helpful in diagnosing FRS and sometimes even in differentiating between different entities. Treatment of FRS should be tailored for each entity. Postoperative medical treatment in AFRS should consider potential advancements described in the literature. This study emphasises the need to combine all types of clinical, radiology, pathohistological and microbiological methods to obtain the best diagnostic and treatment strategies and should be the basis for further research.

Successful treatment of chronic pulmonary aspergillosis in a patient with early pulmonary tuberculosis and COVID-19: a case report.

Chronic pulmonary aspergillosis (CPA) often develops in residual lesions of pulmonary tuberculosis (PTB). Every year, 112,000 to 160,000 people worldwide will develop post-PTB CPA. The simultaneous occurrence of CPA with the first episode of PTB is rare. During the COVID-19 pandemic, COVID-19- associated invasive aspergillosis (CAPA) occurred in patients receiving high doses of corticosteroids and mechanical ventilation. However, CPA and COVID-19 are rarely reported simultaneously. This case study presents a patient with CPA in the first episode of PTB during hospitalization for COVID-19. The favorable evolution is highlighted, including the resolution of the cavitation and fungal ball with appropriate and early treatment. A 48-year-old female patient from the Central West of Brazil was admitted with a history of cough, yellow sputum, fever, and significant weight loss for two months. The respiratory symptoms worsened one week before admission. She tested positive for COVID-19 by RT-PCR. She had a history of hypertension and diabetes. Clinical examination revealed tachypnea, slurred speech, and hypoxia. She presented with hyperglycemia, obesity, hypertension, and an episode of hemoptysis. Chest CT revealed cavitation in the right upper lobe with a 45 mm aspergilloma, multifocal morning opacities, and nodular opacities. Laboratory tests confirmed the PTB with positive sputum for acid-fast bacilli and positive culture for Mycobacterium tuberculosis. The sputum culture also showed Aspergillus spp. She received early treatment for bacterial pneumonia with ceftriaxone, dexamethasone, enoxaparin, an anti-TB regimen, and itraconazole. There was a progressive clinical improvement and the patient was discharged after 15 days. She completed six months of anti-TB therapy and 13 months of itraconazole treatment for CPA, with complete resolution of the cavitation and aspergilloma. This case study presents a unique case of CPA that manifested as simple aspergilloma and was diagnosed concurrently with the initial episode of PTB in a COVID-19 patient with obesity, hypertension, and diabetes. Remarkably, the fungal ball and cavitation regressed spontaneously. The favorable clinical and radiological results highlight the importance of comprehensive treatment approaches for concurrent respiratory infections and emphasize the need to investigate CPA and PTB during COVID-19 hospitalization.

Sphenoid Sinus Fungal Ball and Reestablishing Sinus Function.

The aim was to assess the developmental attributes of sphenoid sinuses affected by fungal balls and describe a surgical approach which reestablishes gravity-dependent drainage to compensate for any mucociliary dysfunction. A within-patient case-control analysis was performed on sphenoid sinus dimensions from patients with sphenoid sinus fungal ball (SSFB). Radiological dimensions were assessed to determine the dominant or larger sinus by volume and width. Pneumatization in the sagittal and lateral extent was assessed. The influence of sinus size and pneumatization variants within a patient was analyzed. Patency and the presence of mucostasis from radical reshaping of the sinus cavity were documented at least 3 months after surgery. Complications (bleeding, cerebrospinal fluid leak, and cranial nerve palsy) were recorded. Twenty-three patients (59 ± 19 years, 86% female, 46 sphenoid sinuses) were assessed. Fungal ball was more common in the smaller (non-dominant) sinus, by width (78% vs. 22%, p < 0.01) and by proportion of total sphenoid volume (0.39 ± 0.16 vs. 0.61 ± 0.16, p < 0.01). Pneumatization variants did not influence the development of SSFB within a patient. All patients had patency and the absence of mucostasis or persistent inflammation at last follow-up. No complications were reported. The smaller or nondominant sphenoid sinus is more affected by SSFB. Surgical reshaping of the sphenoid to prevent mucostasis is favorable in managing the smaller affected sinus cavity. 4 Laryngoscope, 134:4888-4892, 2024.

Maxillary Sinusitis Following Orthognathic Surgery: Should It Be Considered Odontogenic Sinusitis?

Maxillary sinusitis is a recognized complication following dental procedures, but its occurrence after orthognathic surgery, such as Le Fort osteotomies, remains less documented. This case report presents a 58-year-old female who developed unilateral maxillary sinusitis 23 years post-orthognathic surgery. The patient was asymptomatic, aside from occasional cacosmia, and was incidentally found to have sinus opacification on a computed tomography (CT) scan performed for implant-prosthetic rehabilitation. Nasal endoscopy revealed purulence and mucosal edema, prompting endoscopic sinus surgery (ESS). Intraoperatively, purulent material and fungal debris were removed from the maxillary sinus, confirming bacterial sinusitis with a concurrent fungal ball. S. salivarius and Klebsiella species were identified from the cultures. The patient's condition improved following the removal of both the sinus contents and the retained titanium plates and screws. This case underscores the potential for maxillary sinusitis to develop long after orthognathic surgery, particularly in the presence of retained dental hardware. It highlights the importance of thorough imaging and endoscopic evaluation in patients with a history of dental or facial surgeries presenting with sinonasal symptoms. Additionally, it raises questions about the role of retained hardware in the persistence or recurrence of infection and the possible association with fungal ball formation. The need for further research to establish guidelines for the management of sinusitis in such contexts, particularly regarding the removal of facial hardware, is emphasized.

Clinical Significance of Aspergillus Sensitisation in Chronic Pulmonary Aspergillosis.

Aspergillus sensitisation (AS) is seen in many patients with chronic pulmonary aspergillosis (CPA). However, the clinical relevance of AS in CPA remains unclear. In this study, we assess the clinical significance of AS in CPA. We retrospectively analysed the data of CPA subjects, defining AS as Aspergillus fumigatus-IgE ≥ 0.35 kUA/L. We excluded subjects with asthma, allergic bronchopulmonary aspergillosis, chronic obstructive pulmonary disease (COPD) and diffuse parenchymal lung diseases (DPLD). The primary objective was to compare the demographic and clinical characteristics, lung functions (via spirometry) and treatment outcomes in CPA subjects with or without AS. The secondary objective was to explore the association between AS and airflow obstruction on spirometry using multivariable logistic regression analysis. We included 232 CPA subjects (119 females, 113 males) with a mean ± SD age of 42.1 ± 13.7 years. AS was present in 92 (39.7%) CPA patients (CPA-AS group). CPA-AS patients had higher SGRQ total scores, a higher prevalence of fungal ball, more frequent airflow obstruction and experienced more CPA relapses during follow-up compared to those without AS. Airflow obstruction was seen in 77/232 (33.2%) CPA patients. On multivariable logistic regression analysis, we found AS, increasing age and chronic fibrosing pulmonary aspergillosis independently associated with airflow obstruction on spirometry after adjusting for sex and other CPA categories. The relapse-free survival was significantly shorter in the CPA-AS group than in the CPA group. AS is common in CPA and is independently associated with airflow obstruction. More studies are required to confirm our findings.

Misdiagnosis of a fungus ball in the middle ear as chronic suppurative otitis media

Background: Middle ear infections caused by fungi are commonly identified through laboratory tests like fungal smears, culture, and DNA detection. There are two types of ear infections caused by fungi: middle ear fungal infections and fungal otitis media. Both fungal otitis media and fungus balls in the middle ear are increasingly rare. Case Description: A middle-aged immunocompetent woman suffered from long-term recurrent pus formation in the middle ear and associated hearing loss. Physical examination revealed a perforation in the pars tensa of the tympanic membrane; a pure tone audiometry test revealed mild conductive hearing loss. The woman had previously self-medicated with oral antibiotics and/or ear drops multiple times in the past. She did not have a history of diabetes mellitus. She was diagnosed with chronic suppurative otitis media and surgical treatment (tympanoplasty) was advised. Otoscopy-guided tympanoplasty revealed a fungal mass with a cheese-like consistency filling the entire mesotympanum, and important structures such as the ossicular chain and the facial nerve were unharmed. Lesions were meticulously excised from the tympanic cavity of the affected ear. The patient no longer experienced pus formation in the middle ear and loss of hearing was restored after the surgery. After tympanoplasty, the patient did not experience any symptom recurrence during the 10-month follow-up period. Conclusions: If a patient has good immune function and no history of diabetes mellitus, despite repeated antibiotic use resulting in a diagnosis of chronic otitis media, doctors should consider the possibility of a fungal infection in the middle ear.

Nasal septal perforation in fungal rhinosinusitis: A case report

Background: Fungi are ubiquitous in our environment, they can be found in healthy or diseased mucus. Symptoms of fungal rhinosinusitis are different depending on their immunological status. Diagnostic based on history, physical examination, CT scan and histopathological findings. Objective: To report a case of fungal rhinosinusitis with complications. Case Report: A man, 56-year-old with a chief complaint of bad odor in the nose in the last 3 months. CT scan showed bone erosion in the maxillary sinus. Intraoperative found fungus ball in nose cavities and perforated nasal septal. Clinical question: What is the management of nasal septal perforation in fungal rhinosinusitis? Methods: Evidence-based literature study of nasal septal perforation in fungal rhinosinusitis. Result: Treatment for fungal rhinosinusitis is surgery. Antifungal and steroid therapy can be added to reduce recurrence. Conclusion: Debridement surgery is needed for fungal rhinosinusitis. A radiologic test is important to find extra sinuses expansion and bone erosion. Nasal septal perforation is treated by eliminating the cause, applying ointment, saline solution spray, and surgical.

Endogenous Endophthalmitis caused by Abiotrophia/Granulicatella

Purpose To describe a case of endogenous endophthalmitis caused by the bacterium Abiotrophia/Granulicatella adiacens, which clinically appeared consistent with fungal endophthalmitis, in a young patient with a history of intravenous (IV) drug use. Observations A 22-year-old male presented with one week of pain and decreased vision in the left eye. He had a history of IV heroin use. Slit lamp and dilated fundus exam revealed significant intraocular inflammation concerning for endogenous endophthalmitis. The initial clinical impression was of fungal endophthalmitis given the appearance of vitreous opacities consistent with fungal balls. However, vitreous sampling revealed Abiotrophia/Granulicatella adiacens, a species of fastidious gram-positive cocci formerly known as nutritionally variant streptococci. Conclusion We describe Abiotrophia/Granulicatella species causing endogenous endophthalmitis in a patient with a history of IV drug use. Abiotrophia/Granulicatella have not been described previously to cause endophthalmitis. This atypical case expands the spectrum of microorganism’s clinicians should consider when diagnosing and treating endogenous endophthalmitis.

Natural Course of the Maxillary Sinus Fungus Ball: Results From Seoul National University Hospital Healthcare Center.

The frequency of paranasal sinus fungus balls, a common form of rhinosinusitis, has increased. Although treatment and causative factors have been well investigated, the evolving nature of the fungal balls remains unelucidated. This study aimed to investigate and analyze the changing patterns of fungus balls. This retrospective study analyzed data from 35 participants selected from a pool of 41,497 patients who underwent brain magnetic resonance imaging (MRI) at a large health care center. The extent of the fungus balls was evaluated by grading them from 1 to 4 based on the MR images. The changing process of the fungus ball was analyzed based on demographics, interval between the MRI scans, comorbidities, and specific dental interventions. The fungus ball grades showed significant progression over time. In the analysis of 29 sinuses with initially low-grade (grades 0, 1, and 2) fungus balls, 15 sinuses showed a grade change <2 (no/minimal change group), whereas 14 sinuses showed grade changes of ≥2 (substantial change group). Intergroup comparison showed that only the interval between the initial and final MRI scans differed significantly (p = 0.008). However, factors, such as age, sex, comorbidities, and history of dental procedures, did not differ significantly between the two groups. This study shows the extent of change in fungus balls, primarily over time. These results offer critical insights into the natural course and progression of the maxillary sinus fungus ball. 4 Laryngoscope, 2024.

Fungal rhinosinusitis: An integrated diagnostic approach

Classification of fungal rhinosinusitis (FRS) based on histomorphology and clinical presentation aids in early diagnosis and prompt patient management. In this retrospective observational study, clinicopathologic findings in patients diagnosed with fungal rhinosinusitis between January 2019 and December 2021 were evaluated. Clinical and imaging findings were retrieved from hospital records; slides from routine and histochemical studies were reviewed, and the cases were classified into non-invasive [fungal ball (FB) and allergic fungal rhinosinusitis (AFRS)] and invasive FRS [acute invasive fungal rhinosinusitis (AIFRS), chronic invasive fungal rhinosinusitis (CIFRS) and chronic invasive granulomatous fungal rhinosinusitis (CGFRS)]. Fungal cultures were also compared with histopathology. Of the 85 patients in the study, 34 % were non-invasive (86 % FB,10 % AFRS, and 4 % unclassified), and 66 % were invasive (70 % AIFRS, 21 % CGFRS, and 9 % CIFRS). The mean age of patients was 51 years, with a male-to-female ratio of 1.5:1. The most common comorbidity was diabetes with COVID-19 co-infection. Culture reports were available for 77 patients, of which 36 cases had growth, the majority of which were Aspergillus; 7 patients had coinfection with Aspergillus and Mucorales. Comparing histopathology to the gold standard mycology for Aspergillus, a sensitivity of 90 %, specificity of 96 %, and Cohen's Kappa of 0.8 was achieved. This study emphasizes the value of an integrated diagnostic approach in arriving at an appropriate diagnosis. In resource-limited settings, histopathological evaluation can be a valuable screening tool, aiding in early diagnosis.

Diagnostic accuracy of sino-nasal outcome test-22 and lund-kennedy endoscopic score for chronic rhinosinusitis in pre-bone marrow transplantation assessment

Background: The diagnosis of chronic rhinosinusitis (CRS) is a crucial and challenging entity in bone marrow transplantation candidates. We aimed to evaluate the diagnostic accuracy of the Sino-Nasal Outcome Test (SNOT-22) and Lund-Kennedy endoscopic score for the diagnosis of CRS in bone marrow transplantation candidates. Materials and Methods: We conducted a single-center, observational study evaluating bone marrow transplantation candidates by paranasal sinus computed tomography (CT) scan without contrast to measure the Lund Mackay score. Patients with a Lund Mackay score higher than or equal to four or with any evidence of sino-nasal fungus ball in their paranasal sinus CT were considered CRS. The Lund Kennedy endoscopic score and SNOT-22 were also calculated for all participants. Results: This study included 495 patients, of which 63 were diagnosed with CRS. Participants had a median age of 40 (30, 57) years old and 51.3% were male. The Lund Kennedy score and SNOT-22 were correlated with the Lund Mackay score. Furthermore, both SNOT-22 and Lund Kennedy scores were the predictors of CRS based on univariate logistic regression (odds ratio [95% confidence interval (CI)]: 1.10 [1.06, 1.15], 1.37 [1.22, 1.56], respectively). Lund Kennedy score ≥1 had a sensitivity of 0.78 (95% CI: 0.66, 0.87) and a specificity of 0.76 (95% CI: 0.52, 0.83) (AUC [95% CI]: 0.81 [0.75, 0.87]), while SNOT-22 did not yield a remarkable diagnostic accuracy. Conclusion: The Lund-Kennedy endoscopy score could diagnose CRS in bone marrow transplantation candidates with satisfactory accuracy, whereas SNOT-22 lacks enough accuracy to be employed as an independent sino-nasal assessment modality in these patients.

Fungal bezoar of bladder in type 2 diabetic mellitus patient: A case report

A 54 year male, post operated case of bypass surgery presented to a Urologist with acute retention of urine. Patient was relieved by catheterization and bladder irrigation. WBC’s and RBC’s were increased in Urine. Cystoscopy revealed fungal balls in the bladder which on histopathological examination showed aseptate hyphae and spores. Patient was managed by systemic voriconazole and diluted povidone iodine bladder wash. Predisposing factors were diabetes mellitus and dyslipidemia. This case stresses the importance of considering isolated fungal urinary infections in predisposed individuals.

A clinical comparative study of an outpatient treatment group and an endoscopic sinus surgery group for maxillary sinus fungus ball.

This study aimed to clarify the differences in the pathophysiology of maxillary sinus fungus balls (FB) among different case groups and to identify which patients with maxillary sinus FB would be suitable for outpatient procedures. Thirty-four patients diagnosed with maxillary sinus FB between January 2017 and December 2021 were divided into two groups (O and S). We retrospectively compared the clinical and imaging characteristics, and the treatment outcomes between the groups. Group O comprised 12 patients (13 sides) treated in an outpatient clinic and Group S comprised 15 patients (16 sides) treated with endoscopic sinus surgery (ESS). Compared to Group S, Group O had more patients with an enlarged maxillary sinus membranous portion, and shadows indicative of fungal masses (P < 0.01 and P < 0.05, respectively). In particular, the anteroposterior ratio of the open maxillary sinus membranous area was 0.68 ± 0.16 in Group O and 0.5 ± 0.12 in Group S. After surgery, Group O exhibited greater anteroposterior expansion of the maxillary sinus membranous portion compared to Group S (P < 0.01). Additionally, Group O had more patients with shadows in sinuses other than the maxillary sinus (P < 0.01) and medial displacement of the uncinate process (P < 0.01) than Group S. In addition, Group O required fewer procedures and hospital visits than Group S (P < 0.001 and P < 0.01, respectively). Determining the indications for outpatient procedures while considering the pathophysiology of maxillary sinus FB can significantly benefit patients and medical professionals in terms of safety and medical costs.

Chronic Pulmonary Aspergillosis with Tracheobronchial Involvement

Introduction: Aspergillosis is a fungal infection commonly found in human lungs and takes several forms. Chronic pulmonary aspergillosis (CPA) commonly affects individuals with underlying disease, most usually lung tuberculosis (TB). Aspergillosis can cause the formation of a fungus ball in the lung cavity and can also manifest in the tracheobronchial area, although this is rarely seen in immunocompetent patients. Case: A 23-year-old woman came with persistent cough, hemoptysis, and shortness of breath for 4 months. The patient also had a significant weight loss and a history of lung TB 3 years ago. She had completed her lung TB medication. Physical examination showed increased respiratory rate and rhonchi on the left lung. GeneXpert showed no Mycobacterium tuberculosis (MTB) detected. The chest X-ray showed a cavity on the left superior lobe of the lung. Bronchoscopy showed multiple plaques along the trachea, carina, and left main bronchus. A chest computed tomography (CT) scan with contrast enhancement was performed, and a fungus ball was found inside the cavity in the left upper lobe of the lung. The patient was given intravenous fluconazole as therapy and continued with oral fluconazole when discharged. A second bronchoscopy was performed, and improvement was shown. Conclusion: Early detection and treatment should be applied to CPA patients since some studies showed poor prognosis and low five-year survival rates.

WP2.14 - Lung Mycetoma - Chronicles from the Pandemic

Abstract Introduction COVID-19 is a global pandemic which obeys no geographical borders. Post Covid pneumonia sequalae is still an unpredictable course especially with patients with a pre-existing lung compromise. In such scenario, a cohort of patients must also be looked for a fungal infection. Case Study A 31-year-old male presented with history of fever, hemoptysis, and weight loss for 1 month. He suffered from Covid-19 pneumonia 3 months back. He was also diagnosed with Pulmonary tuberculosis 4 years back. Examination revealed right sided tracheal deviation with dull percussion note on the upper and middle zones of the right side of chest. Pulmonary function tests showed a restrictive pattern with a FEV1/FVC ratio of 0.9 (FEV1=2.02, FVC=2.22). Transthoracic echocardiography revealed dextrocardia, moderate TR, and a pulmonary arterial systolic pressure of 25 mm Hg. Contrast enhanced CT scan of thoracic cavity showed reduced right hemithorax, well-defined thick-walled cavities in the upper and lower lobe of the right lung and a ground glass appearance in the bilateral lower lobes. A diagnosis of Lung mycetoma was made along with post covid-19 pneumonia changes. Right posterolateral thoracotomy and right pneumonectomy was performed. Per-operatively, a collapsed lower lobe and stony hard upper and middle lobes of right lung with associated fungal balls were found. Patient was clinically well after a 30-day follow-up period. Conclusion Covid-19 patients with pre-existing pulmonary co-morbidities should be followed with caution and pulmonary symptoms in the post pneumonia patient should raise the suspicion of fungal infections as well.

The accuracy of deep learning models for diagnosing maxillary fungal ball rhinosinusitis.

To assess the accuracy of deep learning models for the diagnosis of maxillary fungal ball rhinosinusitis (MFB) and to compare the accuracy, sensitivity, specificity, precision, and F1-score with a rhinologist. Data from 1539 adult chronic rhinosinusitis (CRS) patients who underwent paranasal sinus computed tomography (CT) were collected. The overall dataset consisted of 254 MFB cases and 1285 non-MFB cases. The CT images were constructed and labeled to form the deep learning models. Seventy percent of the images were used for training the deep-learning models, and 30% were used for testing. Whole image analysis and instance segmentation analysis were performed using three different architectures: MobileNetv3, ResNet50, and ResNet101 for whole image analysis, and YOLOv5X-SEG, YOLOv8X-SEG, and YOLOv9-C-SEG for instance segmentation analysis. The ROC curve was assessed. Accuracy, sensitivity (recall), specificity, precision, and F1-score were compared between the models and a rhinologist. Kappa agreement was evaluated. Whole image analysis showed lower precision, recall, and F1-score compared to instance segmentation. The models exhibited an area under the ROC curve of 0.86 for whole image analysis and 0.88 for instance segmentation. In the testing dataset for whole images, the MobileNet V3 model showed 81.00% accuracy, 47.40% sensitivity, 87.90% specificity, 66.80% precision, and a 67.20% F1 score. Instance segmentation yielded the best evaluation with YOLOv8X-SEG showing 94.10% accuracy, 85.90% sensitivity, 95.80% specificity, 88.90% precision, and an 89.80% F1-score. The rhinologist achieved 93.5% accuracy, 84.6% sensitivity, 95.3% specificity, 78.6% precision, and an 81.5% F1-score. Utilizing paranasal sinus CT imaging with enhanced localization and constructive instance segmentation in deep learning models can be the practical promising deep learning system in assisting physicians for diagnosing maxillary fungal ball.

Surgically treated chronic maxillary sinusitis: Does the odontogenic etiology alone or in combination with a fungus ball matter?

PurposeTo determine whether odontogenic maxillary sinusitis, either alone (OMSw/oFB) or in combination with fungus ball (OMSwFB), is associated with specific clinical characteristics and treatment outcomes compared to non-odontogenic maxillary sinusitis. Materials and MethodsA retrospective cohort study was performed on patients who underwent surgical treatment for chronic maxillary sinusitis between 2013 and 2021. OMSw/oFB and OMSwFB patients, were selected as the study group, while patients diagnosed with non-odontogenic maxillary sinusitis (non-OMS) were enrolled as the control group. Predictor variables were OMSw/oFB and OMSwFB. Outcomes were clinical presentation, postoperative complications, and treatment outcome. Descriptive, bivariate, and multiple logistic regression statistics were calculated, and the significance level was set at P ≤ 0.05. ResultsThe sample included 200 patients with a mean age of 49.6 ± 20.1 years and 57.5 % were men. Of the 200 patients, 123 (61.5 %) had non-OMS, 55 (27.5 %) had OMSw/oFB, and 22 (11 %) had OMSwFB. Multivariate analysis showed that OMSw/oFB was associated with more successful treatment rates (OR = 8.19, p < 0.01), whereas OMSwFB was associated with a less favorable outcome (OR = 0.27, p = 0.03). Age was associated with an unfavorable outcome in both OMS groups (OR: 0.98, p = 0.03 and p = 0.03, respectively), but no significant associations with other outcomes were found. ConclusionThis study suggests that OMSwFB is a recalcitrant form of OMS associated with a higher risk of persistent symptoms and less favorable outcome. These patients should be informed about the challenging nature of the disease and closely monitored.

Insufficient Diagnostic Value of Serum Galactomannan and (1,3)-β-D-Glucan in Paranasal Sinus Fungus Balls.

The serum galactomannan test (GM test) and the (1,3)-β-D-glucan test (G test) are utilized in diagnosing invasive fungal sinusitis. However, their effectiveness in detecting paranasal sinus fungus balls (FBs) has not been established. This study aimed to explore their diagnostic value in patients with FBs. We retrospectively reviewed the medical records of 105 patients (42 with FBs and 63 with chronic rhinosinusitis [CRS]) who underwent serum GM and G tests between June 2020 and May 2021. Olfactory test results and demographics were also analyzed. There were 42 FB patients (10 men, 32 women) and 63 CRS patients (27 men, 36 women). The positivity rates for serum GM (7.1% in the FB group vs. 3.2% in the CRS group, p=0.640) and G test (9.5% in the FB group vs. 11.1% in the CRS group, p=0.482) did not differ significantly between groups. The sensitivities of the GM and G tests were 7.1% and 9.5%, respectively, and their specificities were 96.8% and 88.9%, respectively. The positive predictive values were 60.0% for the GM test and 36.3% for the G test, and the negative predictive values were 61.0% for the GM test and 59.6% for the G test. Serum GM and G tests demonstrated low sensitivity and high specificity, indicating limited effectiveness in differentiating between patients with FBs and those with CRS. Histological examination remains the gold standard for the definitive diagnosis of FBs.