Fungal sinusitis in the immunocompetent patient: Risk factors and surgical management

Background: Fungal sinusitis has been reported increasingly in immunocompetent patients. However, the most effective, appropriate mode of therapy has not been determined. Materials and Methods: In this retrospective study, we examined the records of 110 immunocompetent patients with chronic sinusitis who had undergone sinus surgery at our institution between 1983 and 1994. Five patients (4.5%) with fungal sinusitis were identified. Information on those patients was compared with that of the 105 patients with nonfungal sinusitis. Results: Prolonged use of topical steroids was no more common in patients with fungal sinusitis (20%) than it was in patients with nonfungal sinusitis (4.8%) (p = 0.25). Differentiating features of fungal sinusitis were the presence of a metallic density and areas of high- and low-density on radiologic examination (p < 0.01). All five of the patients with fungal sinusitis were cured by surgical intervention, primarily endoscopic sinus surgery, without undergoing anti-mycotic therapy. Four of the five patients were followed up for at least 3 years without any recurrence. Conclusion: Endoscopic sinus surgery is and should remain the mainstay of treatment for fungal sinusitis in immunocompetent patients. Adjunctive anti-mycotic therapy may not be necessary.