Fungal Sinusitis

What is fungal sinusitis?

Fungal sinusitis (fungal rhinosinusitis) is a sinus infection that results from a fungus (microorganisms like yeast and mold). There are several types of fungal sinus infections, and they all cause similar symptoms like nasal congestion and sinus pain (in your cheeks, forehead and between your eyes).

Providers treat most cases of fungal sinusitis with sinus surgery, and extreme cases may require additional antifungal treatment.

Types of fungal sinus infections

Providers classify fungal sinusitis into two main types:

1. Noninvasive (most common). These infections affect only your nose and sinus areas.
2. Invasive (less common). These infections can spread to other areas, like your eyes and brain. Untreated, these conditions are life-threatening.

Noninvasive fungal sinus infections include:

• Allergic fungal sinusitis: This results from an allergic reaction to fungi inside the nose. 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. As the fungal ball grows, it can block the sinuses.
• Saprophytic fungal sinusitis: Fungus grows on crusts of mucus inside the nose.

Invasive fungal sinus infections include:

• Acute invasive fungal sinusitis: Fungi destroy blood vessels inside the nose, causing the tissue to die. The infection can quickly spread to the eyes and brain, leading to blindness and death. This condition is more common in people with compromised immune systems.
• Chronic invasive fungal sinusitis: This condition is like acute invasive fungal sinusitis, but it doesn’t spread as quickly. People with diabetes are more likely to develop this condition.
• Granulomatous invasive fungal sinusitis (GIFS): This rare type of fungal sinusitis happens when your 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 are fungal sinus infections?

People with weakened immune systems are more likely to develop nasal fungal infections. Severe infections are more common among people who:

• Are HIV positive.
• Have cancer (including leukemia or lymphoma), or are getting chemotherapy treatments.
• Have severe or unmanaged diabetes.
• Take immunosuppressants, including steroids.

What are the symptoms of a fungal sinus infection?

Fungal sinusitis symptoms can resemble symptoms of a regular sinus infection. Additional symptoms depend on the type of fungal infection and whether the infection is invasive.

In general, noninvasive symptoms include, but aren’t limited to:

• Decreased sense of smell.
• Fever.
• Inflammation (swelling) in your nose and sinuses.
• Mucus that looks like rubber cement (usually golden-yellow).
• Nasal congestion.
• Runny nose.
• Sinus pressure.
• Sinus headache.
• Smelling foul odors (like burning or rotting) that no one else can smell.

People with weakened immune systems have a higher risk of serious symptoms like:

• Behavioral changes and neurological conditions (trouble with thinking and reasoning).
• Changes in skin color (your skin may turn very pale or black).
• Facial numbness.
• Changes to your vision, including vision loss.
• Headaches.
• Severe swelling in your cheeks or eyes.

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 breathes them in.

Many types of fungus live on or inside our bodies all the time. They’re usually only dangerous to people who have a weakened immune system.

What are complications of fungal sinusitis?

Untreated, invasive fungal sinus infections can destroy the lining of your nose or spread to your eyes and brain. These complications can lead to tissue loss, blindness and death. People who have conditions that weaken the immune system (like diabetes or leukemia) have a higher risk of these complications.

How are fungal sinus infections diagnosed?

A healthcare provider will start with a physical exam. They’ll ask about your symptoms, health history and medications. Next, they’ll likely want to run some tests, which may include:

• Endoscopy. During this minimally invasive procedure, a provider inserts a long, thin tube with a camera into your nose. The camera shows images of your sinuses. Your provider views these images on a monitor.
• Biopsy. During your endoscopy, your provider may take a small sample of mucus or tissue. This is the only way to know which type of pathogen (virus, bacterium, fungi or parasite) caused your sinus infection. It’s also the only way to detect if there’s an invasion. They’ll send the sample to a pathologist for testing.
• CT scan (computed tomography scan). This imaging test helps your provider see inside your sinuses, locate the infection and check for fungal balls.

How are fungal sinus infections treated?

Fungal sinusitis treatments include:

• Antifungals: Some types of infection require medications to kill the fungus. Providers usually prescribe these drugs along with surgery.
• Corticosteroids: 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 your sinuses. They usually use a saline solution (a mix of water and salt) to cleanse your sinus cavities.
• Sinus surgery: Depending on the type of infection, your provider may do traditional surgery. They’ll remove any infected tissue and thoroughly clean the area. Surgery may also remove structures that are affected in case of invasion.

The type of treatment you need depends on your situation. People with healthy immune systems may not need treatment for some types of fungal sinusitis. But invasive fungal sinus infections are medical emergencies that require immediate treatment.

Can fungal sinusitis be prevented?

You may not be able to prevent a fungal sinus infection. 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.

If you’re immunocompromised, or if you have a higher risk for fungal sinus infections, let your provider know. They may prescribe antifungal medications to prevent an infection before it happens.

What can I expect if I have a fungal sinus infection?

With treatment, most noninvasive fungal sinus infections go away without serious complications. Some types of infection may come back after treatment.

Invasive fungal sinus infections are medical emergencies and require immediate care.

Acute 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?

If you have fungal sinusitis symptoms, see your provider for an evaluation. It’s also important to call your provider if you have sinus issues that don’t seem to go away (chronic sinusitis).

When should I go to ER?

Seek emergency medical care if you have signs of a fungal sinus infection and you:

• Have a condition that weakens your immune system.
• Take immunosuppressant drugs.

A note from Cleveland Clinic

Fungal sinus infections range from mild to very severe. Having fungal sinusitis doesn’t necessarily mean alarm bells — but you should definitely see your healthcare provider so they can begin appropriate treatment. If you have a weakened immune system and you develop fungal sinusitis symptoms, it’s important to seek medical care immediately. Invasive fungal sinus infections can spread fast and lead to other, sometimes life-threatening, complications.