Endoscopic view of allergic fungal sinusitis.

Complete nasal obstruction of 3 months' duration was the complaint of a 36-year-old man. He had no facial pain but complained of pressure in the face and cheek area. Examination of the nose detected extensive polypoid tissue in both nasal airways. Computed tomography (CT) of the sinuses showed extensive soft-tissue obstruction of the nose and paranasal sinuses (figure, A). The patient elected to undergo functional endoscopic sinus surgery. The polypoid tissue was removed with a microdebrider (figure, B). The sinuses were full of thick, muddy-greenish-brown inspissated material (figure, C). After this material was removed, the sinus mucosa was found to be irregular, rubbery, and polypoid (figure, D). The eventual diagnosis of allergic fungal sinusitis was based on a positive fungal stain in the presence of allergic mucus and nasal polyps, as well as a preoperative history of atopy.

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Our understanding of the spectrum of noninvasive fungal diseases in the sinuses continues to engender debate. (1) Although acceptance of formal, universal diagnostic criteria remains incomplete, several common threads continue through descriptions of this entity over the past 2 decades. (2) The endoscopic picture of polypoid disease and thick mucus remains a part of the presentation. Treatment has generally been thought to necessitate the removal of polyps and aeration of the sinuses. (3) The case described here illustrates these endoscopic findings.

References

(1.) Mirante JP, Christmas DA, Yanagisawa E. Endoscopic view of sphenoid fungal sinusitis. Ear Nose Throat J 2005;84:126-7.

(2.) Rains BM III, Mineck CW. Treatment of allergic fungal sinusitis with high-dose itraconazole. Am J Rhinol 2003;17:1-8.

(3.) Mirante JP, Krouse JH, Munier MA, Christmas DA. The role of powered instrumentation in the surgical treatment of allergic fungal sinusitis. Ear Nose Throat J 1998;77:678-80, 682.

Joseph P. Mirante, MD; Dewey A. Christmas, Jr., MD; Eiji Yanagisawa, MD

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Mirante and Dr. Christmas); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).