Allergy, Nose & Sinus

Headaches from fungus in the sinus! (WARNING – GRAPHIC MEDICAL IMAGES!)

February 10, 2020
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Dr Gan saw a patient, Ms A, an 18 year old lady who complained of a few months history of constant heaviness and headaches in the central/back part of her head. She also suffered from a left sided blocked nose and frequent postnasal drip. She has been coughing out clumps of brown material that she wasn’t sure of its significance. She has had multiple courses of oral antibiotics which failed to resolve her symptoms.

 

On nasaoendoscopy, there was mucopus (nose mucous mixed with some pus) in her left nasal cavity. This was suctioned in the clinic and revealed a large polyp occupying most of the left nasal cavity.

 

 

Mucous and some pus filling up most of the left nasal cavity

 

 

After suctioning the mucopus, a large polyp can be seen

 

 

As her nasal polyp was unilateral (one sided), a CT scan scan of the sinus and a biopsy of the nasal polyp was performed to rule out a tumour. The CT scan showed complete blockage of the left sphenoid sinus (the sinus behind the eyes, close to the brain). The appearance of the CT scan  suggested a possible fungal concretions in her left sphenoid sinus. The biopsy of the nasal polyp was consistent with an inflammatory polyp (non tumour).

 

 

A CT scan of the head (axial cut) showing complete opacification (blockage) of the left sphenoid sinus

 

 

Ms A underwent a left functional endoscopic sinus surgery (FESS) to remove the inflammatory polyp and to drain her blocked left sphenoid sinus. During surgery, fungal concretions (clumps of fungus) was found stuck and completely filling up the left sphenoid sinus. This was removed.

 

Fungal ball (fungal concretions) in the left sphenoid sinus during surgery

 

 

Fungus removed from the nose

 

 

Fungus removed from the nose

 

 

The mucosa (lining of the sinus) of the left sphenoid sinus was swollen and inflamed from the long standing infection. About a month after the surgery, Ms A’s left sphenoid sinus has completely healed. She no longer suffers from postnasal drip or headaches that used to trouble her.

 

The sphenoid sinus is one of the deepest sinus in the head. There are many important structures close to the sphenoid sinus, including the brain, nerves and large blood vessels. Hence, an infection in this sinus should be treated to prevent spread to the surrounding critical structures. We do not know why some people are prone to having a collection of fungus (commonly called Fungal Ball) in the sinus. The most common sinus where Fungal Balls occur is in the maxillary (cheek) sinus. One of the known risk factor for this is a history of previous dental procedures. Fungal Balls can be a source of secondary bacterial infection and may block the sinus completely, like in the case of Ms A. The treatment is usually surgical removal (through a minimally invasive procedure through the nose called FESS) and the clinical outcome is usually excellent.

 

 

 

 

 

 

 

 

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