🌿 Aspergillosis in the Sinuses (Allergic Fungal Rhinosinusitis – AFRS)

It’s quite possible for Aspergillus to affect both the lungs and the sinuses.
The sinuses are small air-filled spaces behind the nose, eyes, and cheeks that normally drain mucus freely. When Aspergillus spores become trapped there, they can trigger an allergic or inflammatory reaction — rather like ABPA in the lungs.

This allergic form is called Allergic Fungal Rhinosinusitis (AFRS).
It isn’t a contagious infection — it’s an overreaction of the immune system to fungal spores. Over time, it can lead to thick mucus, nasal blockage, and sometimes nasal polyps.

🩵 Common symptoms

• Persistent nasal congestion or blockage

• Thick or sticky mucus (sometimes with brown or dark flecks)

• Reduced or lost sense of smell

• Facial pressure, pain, or fullness (especially around the eyes or cheeks)

• Post-nasal drip (mucus running down the throat)

• Fatigue or worsening asthma symptoms

🔬 Diagnosis

• CT scan of the sinuses – shows thickened or blocked areas

• Nasal endoscopy – a tiny camera used to look inside

• Fungal culture or microscopy from mucus samples

• Blood tests – sometimes show raised total IgE or Aspergillus-specific IgE

💊 Treatment

• Topical nasal steroids (sprays or rinses) or short courses of oral steroids to reduce inflammation

• Saline rinses to help keep the sinuses clear

• ENT surgery if sinuses are blocked or filled with thick fungal debris

• Antifungal medication in some cases, especially if fungal growth is confirmed

🌸 The Main Types of Aspergillus Sinus Disease

There are several recognised types of sinus aspergillosis. Most people with ABPA or asthma experience only the allergic form (AFRS).

1️⃣ Allergic Fungal Rhinosinusitis (AFRS)

• Caused by an allergic reaction to Aspergillus

• Leads to inflammation, thick mucus, and polyps

• Non-invasive – the fungus stays on the surface

• Managed with steroids, nasal rinses, and sometimes surgery
  ✅ This is the type most relevant for ABPA patients.

2️⃣ Fungal Ball (Mycetoma)

• A clump of fungus (usually A. fumigatus) in a single sinus, often the cheek (maxillary) sinus

• Common in otherwise healthy people

• Causes chronic congestion or facial pain

• Treated surgically – antifungals rarely needed

• Not allergic and not invasive

3️⃣ Invasive Aspergillus Sinusitis

• Rare, seen mostly in people with severely weakened immunity (e.g., chemotherapy, bone marrow transplant, uncontrolled diabetes)

• The fungus invades surrounding tissue and blood vessels

• Causes severe facial pain, swelling, fever, sometimes affecting the eyes

• Needs urgent treatment with antifungal drugs and surgery
  ⚠️ Very rare in people with ABPA or CPA.

🤝 Specialist care

If you have lung aspergillosis (such as ABPA or CPA) and start noticing more nasal congestion, sinus pressure, or post-nasal drip, it’s sensible to mention it to your respiratory or mycology team.
At the National Aspergillosis Centre (NAC), sinus disease is often co-managed by ENT surgeons, respiratory physicians, and mycology specialists, ensuring coordinated care.

With the right combination of treatments — and early recognition of symptoms — most people find their sinus symptoms improve, and controlling sinus inflammation can even help with overall breathing and energy.