Fungal Sinusitis (Fungal Sinus Infection)
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What is fungal sinusitis?
Fungal sinusitis (fungal rhinosinusitis) is a sinus infection that results from a fungus. Several types of fungal sinus infections cause similar symptoms. These may include nasal congestion and sinus pain (in the cheeks, forehead and between the eyes).
Providers treat most cases of fungal sinusitis with sinus surgery, and extreme forms may require additional anti-fungal treatment. But people with healthy immune systems may not need treatment. Some fungal sinus infections clear up without intervention.
People who have conditions that weaken the immune system (such as diabetes and leukemia) are much more likely to get fungal sinusitis. They also have a higher risk of complications. Some types of fungal sinusitis can destroy the lining of the nose, spread to the brain and lead to death.
What is a fungus?
A fungus is a living organism. It can’t make its own food, so it takes its nutrients from decomposing matter in the soil, water or plants where it lives. Fungi live in the air, on surfaces, and on humans and other animals.
Scientists classify fungi in groups. They include mold, yeasts and mildew. Some fungi are big enough to see (like mushrooms), and some are so small you can only see them with a microscope.
There are more than 100,000 species of fungi. They live all around us, and most aren’t dangerous. But some fungi can invade the body and multiply, leading to serious health problems. Different types of fungi cause infections in many parts of the body. Some examples are yeast infections, thrush and toenail fungal infections.
What are the sinuses?
The sinuses are hollow, interconnected spaces (cavities) inside your skull. They extend across your forehead, behind your nose, between your eyes and under your cheekbones. Sinus walls have a layer of mucus that traps bacteria and keeps the air inside moist.
Sinuses need to drain frequently. If there’s a blockage or inflammation, the sinuses don’t work like they should.
What are the types of fungal sinusitis?
Providers classify fungal sinus infections as invasive and noninvasive. Invasive infections can spread to other areas, such as the eyes and brain. Noninvasive sinus infections, the more common type, only affect the nose and sinus areas.
The types of noninvasive fungal sinusitis are:
- Allergic fungal rhinosinusitis: This is the most common type of fungal sinus infection. It results from an allergic reaction to fungi inside the nose. Untreated, the sinuses fill up with thick mucus and nasal polyps can form. People with asthma or allergic rhinitis (hay fever) are more likely to develop this condition.
- Fungal ball (mycetoma): Fungi build up in the sinuses and form a clump or ball. The fungal ball can get bigger and block the sinuses. Providers use surgery to remove fungal balls and clean out the sinuses.
- Saprophytic fungal sinusitis: This type of infection doesn’t actually affect the nose tissue. Instead, fungus grows on crusts of mucus inside the nose. When providers remove the crusts, they remove the fungus, too.
Untreated, invasive sinus infections are life-threatening. The infection can destroy tissue inside the nose and move into the skull and brain. The types of invasive fungal sinusitis are:
- Acute fulminant invasive rhinosinusitis: This life-threatening condition is more common in people who have a compromised immune system. Their immune system may be weak due to cancer, chemotherapy or after an organ transplant. Fungi destroy blood vessels inside the nose. Without a blood supply, the tissue begins to die. The infection can quickly spread to the eyes and brain, leading to blindness and death. Providers also call this condition acute invasive fungal sinusitis and mucormycosis.
- Chronic invasive rhinosinusitis: People with diabetes are more likely to have this type of sinusitis. It’s similar to acute fulminant invasive rhinosinusitis, but it doesn’t spread as quickly.
- Granulomatous invasive fungal sinusitis (GIFS): This rare type of fungal sinusitis happens when the body launches an immune response to fungi. The person’s immune system attacks the lining of the nose and destroys the nasal tissue. Providers aren’t sure why the immune response happens.
How common is fungal sinusitis?
Some types of fungal sinusitis are more common than others. Women are much more likely to develop fungal balls than men. Allergic fungal sinusitis is more common in warm, humid climates. GIFS is very rare in the United States. It’s much more common in India, Sudan and Pakistan.
Fungal sinus infections have increased over the last few decades. This may be because healthcare providers are prescribing more antibiotics and immunosuppressant drugs. This increase could also be due to a rise in the number of diseases that weaken the immune system.
People with weakened immune systems are more likely to develop fungal sinus infections. Severe infections are more common among people who:
Symptoms and Causes
What are the symptoms of fungal sinusitis?
Symptoms of fungal sinusitis include:
- Decreased sense of smell or a bad smell in the nose.
- Inflammation (swelling) in the nose and sinuses.
- Nasal congestion and runny nose.
- Pain, tenderness and pressure in the sinus area. It may hurt when you touch your cheeks or forehead.
- Sinus headache.
People with weakened immune systems have a higher risk of serious symptoms of fungal sinusitis. These include:
- Behavioral changes and neurological problems (trouble with thinking and reasoning).
- Changes in skin color (the skin may turn very pale or black).
- Facial numbness.
- Proptosis (eyeballs that protrude, or stick out, from the eye sockets).
- Severe swelling in the cheeks or eyes.
- Vision changes, vision loss and blindness.
What causes fungal sinusitis?
Several types of fungi can cause a sinus infection. Most fungal sinus infections result from mold or yeast. Tiny fungi can enter the sinuses when someone breaths them in.
Many types of fungus live on or inside the body all the time. They’re usually only dangerous to people who have a weakened immune system.
Diagnosis and Tests
How do healthcare providers diagnose fungal sinusitis?
To diagnose a fungal sinus infection, your provider will do a physical exam. They will ask about your symptoms, health history and medications. Then, your provider may remove some mucus or tissue from your sinuses and send it to a lab. The lab tests for fungus.
Your provider may also order a CT scan. This imaging study uses X-rays and a computer to see detailed images of your sinuses. It helps your provider locate the infection or check for a fungal ball. It also helps them develop an effective treatment plan.
An endoscopy can also help your provider diagnose and evaluate a fungal sinus infection. During this procedure, your provider inserts a long, thin tube with a camera into your nose. The camera shows images of your nose and sinuses. Your provider views these images on a monitor.
Management and Treatment
How do providers treat fungal sinusitis?
Fungal sinusitis treatments vary. People with healthy immune systems may not need treatment for some types of fungal sinus infections. Invasive fungal sinus infections require immediate treatment.
- Antifungal medications: Some types of infection require medications to kill the fungus. Providers usually prescribe these drugs along with surgery.
- Corticosteroid medications: Your provider may prescribe steroids to reduce inflammation and relieve sinus pressure.
- Nasal wash: To treat saprophytic fungal sinusitis, providers remove crusts of mucus and wash out the sinuses. They usually use a saline solution (a mix of water and salt) to cleanse the sinus cavities.
- Surgery: Depending on the type of infection, your provider may do traditional surgery or minimally invasive endoscopic surgery. They insert a long, flexible tube with a camera into your nose and use tiny tools to remove the fungus, fungal ball and any damaged tissue.
Can I prevent fungal sinusitis?
You may not be able to prevent a fungal sinus infection. If you’re at a higher risk for fungal sinus infections, talk to your provider. They may recommend regular checkups to monitor your health and treat infections quickly. Talk to your provider if you:
- Have had a fungal sinus infection in the past.
- Have a health condition that weakens your immune system.
- Take immunosuppressant drugs or are getting chemotherapy treatments for cancer.
Outlook / Prognosis
What is the outlook for people with fungal sinusitis?
With treatment, most noninvasive fungal sinus infections go away without serious complications. Some types of infection may come back after treatment.
Untreated, invasive fungal sinus infections can spread to the eyes and brain. They can lead to tissue loss, blindness and death.
Acute fulminant invasive fungal sinusitis is fatal about 50% of the time. This infection worsens very quickly, so it’s essential to get treatment as soon as possible. After treatment, some people have nerve damage, chronic pain or facial abnormalities due to lost tissue.
When should I see my healthcare provider about fungal sinusitis?
If you have symptoms of a sinus infection, see your provider for an evaluation. It’s also important to call your provider if you have sinus problems that don’t seem to go away (chronic sinusitis).
If you have a condition that weakens your immune system or you take immunosuppressant drugs and you notice sinus infection symptoms, get help immediately. People who have weakened immune systems are at a higher risk of death from a fungal sinus infection. Some infections spread quickly, so it’s essential to seek treatment right away.
A note from Cleveland Clinic
If you have symptoms of a sinus infection, see your provider. They will determine what’s causing your symptoms and recommend the most appropriate treatment. If you have these symptoms and you take immunosuppressant medications or have a condition that weakens your immune system, get help right away. Invasive fungal sinus infections are very dangerous and can worsen quickly. They may be fatal without prompt treatment. If you have a compromised immune system, talk to your provider about getting regular checkups to monitor your health.
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