Unable to tolerate the recurrent episodes of sinusitis, Ruchir Hazarika (28) of Tezpur consulted an ENT specialist. “My sinuses were inflamed for as long as I could remember. My parents took me to an ENT expert a few times, but after that, we would not bother to consult one. I used over-the-counter (OTC) nasal sprays when I had nasal congestion.” But when it became frequent and even OTC antibiotics could not give him long-term relief, he decided to consult an ENT expert.
Hazarika had trouble sleeping due to a nose blockage or non-stop sneezing. Initially, he thought it was a seasonal allergy as he had a history of it. However, it got worse eventually.
Hazarika was asked to do a CT scan. “After the reports came, my doctor told me that I had something called a fungal ball ( a localised fungal infection that can occur in the sinuses) in my left maxillary sinus (a hollow space in the bones around the nose) that was causing complete opacification of the sinus (total blockage of the sinus),” he says. Hazarika had to undergo minor surgery for the removal of the fungal ball and was prescribed a few medicines.
Know more about the anatomy of the nose.
“I had to go for a few follow ups to ensure that there was no residual fungal infection and I gradually got better,” he adds.
Understanding sinusitis
The sinuses are empty spaces or cavities within the skull that are connected to each other, says Dr Mahesh Meda, visiting consultant, ENT, Narayana Multispeciality, Bengaluru. They are located in various parts of the face, such as behind the nose, under the cheekbones, and between the eyes. The walls of the sinuses are lined with a layer of mucus that helps to capture bacteria, remove them, and prevent the air inside from drying out.
“For the sinuses to function properly, they must be able to drain regularly. However, when there is a blockage or inflammation, the sinuses are unable to perform their normal functions. This condition is known as sinusitis,” Dr Meda says. When the infection is due to fungus, it is known as fungal sinusitis.
Who are at the risk of fungal sinusitus
Dr Sangeeta Varty, consultant ENT at PD Hinduja Hospital and Medical Research Centre in Mumbai, says that while anyone can contract it, certain individuals are at a higher risk. These include:
- Individuals who are immunocompromised (having low immunity)
- those with underlying conditions such as diabetes
- individuals who have been on long-term steroid treatment
- and those who have undergone organ transplants
Symptoms
According to Dr Meda, the symptoms of fungal sinusitis are:
- Discomfort in the sinus
- Nasal congestion
- Loss of smell/bad smell
- Runny nose
- Bleeding in the nose
- Headache
- Pain in the nose
Causes
Sinus infections can be caused by different types of fungi, including mould and yeast, which can enter the sinuses through inhalation, says Dr Meda. Normally, various fungi coexist with the human body without causing harm, but individuals with weakened immune systems are more vulnerable to their harmful effects.
Types
According to Dr Varty, fungal sinusitis can be broadly classified into invasive and non-invasive fungal sinusitis.
She further explains each type and its sub types:
Invasive fungal sinusitis: It is a severe condition where the fungus infiltrates the sinuses and surrounding tissues. It can be fatal too.
The types of invasive fungal sinusitis are:
Acute fulminant fungal rhinosinusitis: It is a rapidly progressing and severe form of fungal sinusitis. It typically occurs in immunocompromised individuals and is characterised by a sudden deterioration in the individual’s health. In this infection, the fungus spreads to the surrounding tissues and damages them.
Chronic invasive rhinosinusitis: Chronic invasive rhinosinusitis is a type of fungal infection that typically develops over a longer period, lasting up to 12 weeks. The onset of symptoms is slower and less severe. Individuals with this condition may experience an enlarged mass in the cheek, nose, or eye area, and the infection can spread beyond the sinuses.
Non-invasive sinusitis: It is a less severe form of sinusitis where the infection does not penetrate into the surrounding tissues and affects only the nose and the sinuses.
The types of non-invasive fungal sinusitis are:
Fungal ball: It is a dense mass of fungal hyphae that forms in one of the sinus cavities, most commonly in the maxillary sinus. This condition is also known as a mycetoma. The mass can cause blockages and lead to congestion and facial pressure.
Allergic rhinosinusitis: Allergic rhinosinusitis is a type of sinusitis caused by an allergic reaction to fungal spores. This condition can occur when an individual is exposed to a high fungal content. Symptoms may include nasal congestion, sneezing, and itchy eyes. Individuals may also develop nasal polyps, which are non-cancerous growths that form in the lining of the nose. It can recur, and requires ongoing management of allergies and associated symptoms.
Diagnosis and treatment
Dr Varty and Dr Meda emphasise the importance of conducting a thorough examination of individuals based on their symptoms and medical history. They may collect mucus or tissue samples from the sinuses and do fungal infection testing. “Additionally, a CT scan may be ordered to produce detailed images of the sinuses, which can help in identifying the infection’s location and formulating an effective treatment strategy,” says Dr Varty.
An endoscopy, where a camera is inserted into the nose to visualise the sinuses, may also be used to diagnose and assess fungal sinus infections. Based on the diagnosis, the treatment options vary. Immediate treatment is necessary for invasive fungal sinus infections. “Treatment options include prescribed antifungal medications, corticosteroid medications, nasal washes or sprays, and surgery,” says Dr Varty.
