Non-Invasive Fungal Sinusitis

Dr. K. R. Meghanadh

What is Non-Invasive Fungal Sinusitis?

Non-invasive fungal sinusitis is the most common type of the three types of fungal sinusitis. It is the most common and least dangerous among the three types. In fact, when a doctor says fungal sinusitis, he means non-invasive fungal sinusitis.

Only if the fungal sinusitis is other than non-invasive, they mention the type. Even when we google fungal sinusitis, most articles are about non-invasive but just refer to infection as fungal sinusitis.

Non-invasive fungal sinusitis is a condition where the growth of fungi is restricted to the sinus cavities without invading surrounding tissues. To kill the fungus, we require killer cells in the body, which are in limited proposition. Because the fungus multiplies fast, our body cannot produce enough killer cells at similar rates to tackle the fungus. So, instead, our body will continuously check to prevent the fungus from getting into the blood or tissue by creating a barrier around the sinuses. This process will continue for a very long time.

Causes

Non-invasive fungal sinusitis is typically caused by the presence of fungi within the sinus cavities. However, the specific circumstances that lead to fungal infection in the sinuses are not clearly defined.

One speculative theory suggests that when sinusitis (bacterial sinus infection) occurs, the immune system produces white blood cells (WBCs) to combat the infection in the sinuses. These WBCs enter the sinuses to eliminate bacteria. Once the bacteria are neutralized, the WBCs face a challenge in returning to the bloodstream. They need to be drained through the natural drainage process. Unfortunately, inflammation in the sinuses can block the drainage pathway. As a result, the fluid containing a substantial amount of dead bacteria and WBCs may struggle to exit the sinus. This stagnant fluid can transform into pus, providing a nutrient-rich environment for the fungus to grow, leading to the development of fungal sinusitis.

Types

The non-invasive fungal sinusitis can be of two types:

1. Allergic fungal rhinosinusitis

2. Fungal ball

Allergic Fungal Rhinosinusitis

In allergic fungal rhinosinusitis, most problems are due to allergies. The fungus is very limited in number, but the body overreacts to the fungus. Usually, in allergic fungal rhinosinusitis, there will be a strong allergic reaction from the body to minimal fungus. If there is no reaction, then the fungus will increase.

Fungal Ball in Sinuses

In a fungal ball, there will be a massive amount of fungal material, and the body will not respond. The body responds to an outside organism in two ways: one is an allergic type, and the other is a killing one. If the allergic type is more, they will develop allergic fungal rhinosinusitis. If the response for the body is very negligible, then it grows into a fungal ball.

Symptoms of Non-Invasive Fungal Sinus Infection

In the initial stages of non-invasive fungal sinusitis, the symptoms are similar to a bacterial or regular sinus infection.

1. Runny nose

2. Nose block

3. Headache

4. Facial pain

5. Phlegm oozes from the nose to the back of the throat; thus, there is a need to clear the throat.

6. Sore throat

7. Frequent attacks of cough

These symptoms are very mild or even absent, so it is hard to identify non-invasive fungal sinusitis. Even if we have symptoms, they are because of bacterial sinusitis, not because of the fungus, which lives silently in the sinuses.

Sometimes, the fungus starts to flare up whenever the immunity is compromised; at that point, the protective wall created by our immunity around the sinuses will give way to the fungus. That could be the wall between the eye & sinus or the sinus & brain. The fungus will spread to adjacent places and start pressuring the important structures of the eye or brain, but it will not spread to them. Due to the pressure on the eye and brain, there will be symptoms related to the eye or brain. In this case, we can identify it by using endoscopy and CT scans.

There are many cases where patients get CT scans for other purposes and find fungal sinusitis. Because when there is no secondary infection, the symptoms are always less or even absent. So, we don't even know we have a fungal infection unless we get a CT scan.

Diagnosis

As mentioned above, it is difficult to identify non-invasive fungal sinusitis based on the symptoms. Even if the symptoms are shown, they are mostly allergic reactions or symptoms of bacterial sinusitis that coexist with the fungal sinus infection.

Endoscopy and CT Scan

We diagnose the non-invasive fungal sinusitis by performing an endoscopy and CT scan. During endoscopy, if doctors find any fungal material coming from the sinus into the nose. Doctors will send it for culture and examination, where they will examine it under a microscope to identify if there is a fungal infection. Also, by doing different mycological studies, we can identify the type of fungus.

Fungal Smear

A fungal smear is also known as a potassium hydroxide smear. In this, we take a drop of puss obtained in endoscopy and put it on a glass slide along with potassium hydroxide. Here, the potassium hydroxide will kill or dissolve the cell walls of bacteria or other organisms. So, after waiting for some time, all the cell walls get dissolved. However, the fungus can withstand the potassium hydroxide solution, so these cells will remain alive, making it easy to identify or observe the fungus. Food, water, and proper temperature are provided to the fungus for two to 14 days. The fungus will grow from one spore to a full-grown plant, making it easy to determine the type of fungus it is, depending on its character.

Treatment

Fungal Ball Non-Invasive Treatment

For fungal ball patients, we must open the sinus to drain the fungus. The natural ostium of the sinus must be widened so that, in the future, there is no scope for the stagnation of fluids. By now, we already know that fungus will grow in the stagnated fluid. So, if we don't allow the fluid to stay in the sinus, the fungus cannot form, so we have to make a big opening so that the fluids can come out easily.

Allergic Fungal Rhinosinusitis Treatment

In allergic fungal sinusitis, most complaints are because of the allergic reaction. So there will be a lot of polyps, secretions coming into the nose, sneezing, itching in the nose, and phlegm or fluid going into the different parts of the nose, causing complaints.

Initially, in this scenario, we give antiallergic medication, which brings down the symptoms. Sometimes, we even prescribe steroids to reduce inflammation. After that, doctors will perform surgery to clear the sinus and remove the stagnated fluid and widen the sinus opening so that there will be no stagnation of fluids in the future. If we don't allow the fluid to stay in the sinus, the fungus won't grow, which decreases allergic reactions.

Antifungal Treatment for Non-Invasive Fungal Sinusitis

Usually, for non-invasive fungal sinusitis, antifungal treatment is not the primary treatment. If the fungal number is higher in the fungal ball or even in allergic fungal rhinosinusitis, doctors will use antifungal medications to support the treatment. For the fungal ball, we need to give the antifungal medicine and the surgery. In allergic fungal rhinosinusitis, the antifungal medication should go along with the antiallergic medications and surgery.

Dr. K. R. Meghanadh