Fungus ball of the maxillary sinus: clinical and diagnostic characteristics

Fungus ball of the maxillary sinus (FBMS) is the most common form of chronic fungal rhinosinusitis in adults. It is a condition of old age, usually with unilateral involvement, and with female preponderance. It is especially described in immunocompetent individuals and is characterized by a slow and benign evolution. Although the etiology, pathogenesis and natural history of fungal rhino-sinusitis have been studied extensively, they are far from being fully understood. The clinical presentation and endoscopic findings in patients with fungus ball of the maxillary sinus are nonspecific, often identical to those of chronic bacterial rhinosinusitis and the cultures are often negative. Imaging evaluation by CT scan suggests, by characteristic signs, a correct diagnosis, which is then correlated with the histological identification of fungal hyphae. Microbiological, histopathological and mycological examinations of nasal secretion established with certainty a variety of bacteria (70%) and fungi (61.7%) in a group of 60 patients with FBMS included in a three-year study. The most commonly detected bacterial floras were Staphylococcus aureus, Citrobacter Koseri, Haemophilus influenzae, Pseudomonas aeruginosa, Moraxella catarrhalis and Klebsiella oxytoca. On culture media, the most common fungal agents were Aspergillus fumigatus and Aspergillus flavus.