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The web site for people with sinus problems

Treatment of fungal sinusitis: Mostly surgical.

Allergic Fungal sinusitis and mycetomas (or fungus balls) in the sinuses are treated quite differently, but both typcially will require surgery. Without surgery, there is usually little chance that the fungus will be cleared from the sinuses. There is a simple reason for this. The openings of the sinuses (if a patient has never had surgery) are very small, on the order of 2-4mm in size. However, the fungal material that can occassionally grow in the sinuses (remember its not commmon) can be 1 or 2 cm or larger in size. So, its rare, even with great medical management for fungus in the sinuses to "clear itself", even with medical treatments. Aside from the size of the fungal mass being too large, the fungus is also usually very sticky, so even when we perform surgery and open the sinuses widely, its still difficult to clear out all of the fungal material, often times.

So both types of fungal sinusitis, the allergic fungal sinusitis and the mycetoma (or fungus ball) usually require surgery.

What is the difference in surgery for mycetomas versus allergic fungal sinusitis?

When doing surgery for either type of fungal infection, it is critical to remove all of the fungus from the sinus, at least everything that can be seen. If a small bit of mycetoma is left, it can fester, become infected with bacteria, and serve as a "foreign body" or source of continued (bacterial as well as fungal) infection.

When surgery is being performed for allergic fungal sinusitis, it is also important to remove all of the visible fungus. Otherwise, the remaining fungus will stimulated (or continue to stimulate) the allergic response, more polyp formation. These polyps will trap more fungus, and cause a snowball effect--more polyps, trap more fungus, which stimulates more polyps. In fact, because this is the case, it is typical for the average patient to require 2 operations to rid the sinuses of fungus (after the fungus is recognized as the problem). Sometimes it takes time (and operations) to identify that fungus is the problem.

After sinus surgery for allergic fungal sinusitis, patients are usually put on oral steroids to reduce the allergic response, while the area heals. Patients are usually slowly tapered of the steroids, lowering the dosage of steroid as the sinus heals properly. Dosages are decreased if the patient is healing without signs of infection or recurring polyps. Recurrring polyps usually are suspicious for residual trapped fungus.