ENT Department , CHU UCL Mont-Godinne, Yvoir, Belgium.
Rhinology. 2013 Jun;51(2):181-8. doi: 10.4193/Rhino12.114.
A fungal ball consists of a dense conglomerate of fungal hyphae growing at the surface of the sinus mucosa without tissue infiltration. The maxillary sinus is by far the most commonly involved paranasal sinus cavity followed by the sphenoid sinus. The present study is a retrospective study of 25 consecutive cases treated during the last 10 years in the two hospitals be- longing to the Catholic University of Louvain (CHU Mont-Godinne and UCL Saint Luc). We report the symptomatology, the imaging and discuss the different surgical managements. We conclude that the clinician must have a high index of suspicion when dealing with a unilateral rhinosinusitis persisting despite a maximal and well conducted medical treatment. This is particularly so in elderly women when associated with facial pain and post nasal drip, particularly when the computed tomography shows an unilateral opacity of the sphenoid sinus with or without a sclerosis or an erosion of the bony walls, a polyp in the sphenoethmoidal recess or a hyperdensity mimicking a foreign body. An endonasal endoscopic sphenoidotomy is the treatment of choice in most cases, allowing good ventilation of the sinus and radical removal of all the fungal concretion. A biopsy of the sinus mucosa adjacent to fungal elements is of upmost important to confirm the non- invasiveness of the fungi within the tissue. Antifungal medication is not required in uncomplicated forms. All host factors producing some degree of immunosuppression must be corrected when present and must alert the clinician to rule out any forms of invasive disease.
真菌球由密集的真菌菌丝组成，生长在窦黏膜表面，没有组织浸润。上颌窦是迄今为止最常受累的副鼻窦，其次是蝶窦。本研究回顾性分析了过去 10 年在两所隶属于鲁汶天主教大学（CHU Mont-Godinne 和 UCL Saint Luc）的医院连续治疗的 25 例病例。我们报告了其症状、影像学表现，并讨论了不同的手术治疗方法。我们得出结论，当单侧鼻窦炎持续存在，尽管经过最大程度和良好的药物治疗后仍未缓解时，临床医生必须高度怀疑该病。当这种单侧鼻窦炎与面部疼痛和后鼻滴涕相关时，尤其是当计算机断层扫描显示单侧蝶窦不透明，伴有或不伴有骨壁硬化或侵蚀、蝶筛隐窝内有息肉或类似异物的高密度影时，这种情况尤其如此。对于大多数病例，经鼻内镜蝶窦切开术是首选治疗方法，可使鼻窦良好通气，并彻底清除所有真菌凝结物。对邻近真菌的窦黏膜进行活检对于确认组织内真菌的非侵袭性至关重要。在单纯形式下不需要使用抗真菌药物。所有引起一定程度免疫抑制的宿主因素都必须纠正，并且必须提醒临床医生排除任何形式的侵袭性疾病。
