Fungi (mold) are plant-like organisms that exist throughout the environment. They thrive in moist, dark cavities, such as the sinus cavities. Recent studies from the Mayo Clinic indicate that there are probably multiple types of fungi in everyone’s nasal passages, but certain people may have an overactive response to these fungi and subsequently develop chronic sinusitis. Fungus probably represents one of a number of environmental “triggers” that can incite an inflammatory response in susceptible individuals. Whether or not they play a primary role in all types of chronic sinusitis is still under investigation. There are four basic type of fungal sinusitis.

Fungus balls are clumps of spores that usually occur in a single sinus. They occur in individuals with normal immune systems and can cause typical signs of chronic sinusitis. Treatment consists of surgical removal of fungal debris and anti-fungal antibiotics are usually not necessary. 

Allergic fungal sinusitis (AFS) is believed to represent an immune-mediated, allergic-type response to environmental fungi that are dispersed into the air. AFS appears to be more common in warm, humid environments, such as South Carolina, where molds and fungus are abundant. Patients often have other environmental allergies, nasal polyposis, and can have asthma. This condition results in thick fungal debris and sticky mucus that must be surgically removed in order to keep the inflammatory condition under control. At times this massive nasal polyposis and fungal debris can expand and erode towards the eyes or brain.

Surgeons can endoscopically remove polyps and fungal debris that are adjacent to the skull base (SB) and eye (E) while preserving normal structures, such as the septum (S) and middle turbinate (M).

Allergic Fungal Sinusitis (AFS)

Medical treatment consists of oral (prednisone) and topical steroids and immunotherapy (allergy shots). In spite of aggressive treatment, recurrence is not uncommon.

Invasive fungal sinusitis occurs in immunocompromised patients (such as those undergoing chemotherapy or bone marrow transplants or AIDS patients) when the body is unable to fight the fungus. The disease often leads to fungal invasion of the eye and/or brain. In spite of treatment with aggressive surgical removal and intravenous anti-fungal medications, the disease is often fatal.

Chronic invasive fungal sinusitis is rare in the US and occurs most commonly in the Sudan or India. Patients with normal immune systems develop a slowly invasive, progressive infection that can be fatal. Treatment is with aggressive surgery and anti-fungal medications. 

 How is Sinusitis Diagnosed?

Patient Education Interactive Tutorials:
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 Sinus Surgery (Patient Education Institute)- Medlineplus

Other Online Resources:

 Fungal Infections (National Library of Medicine)

 Aspergillosis (Merck & Co., Inc.)

 Mucormycosis (Merck & Co., Inc.)