The sinuses are cavities located within the skull around the nose, under the bones of the cheeks and forehead. Two distinct types of Aspergillus sinusitis exist, both in people who have healthy immune systems:
Allergic Fungal Rhinosinusitis
Symptoms are nasal airways obstruction (difficulty breathing through the nose), allergic nasal congestion (blockage as a result of being exposed to something the person is allergic to), purulent rhinorrhoea (thick green ‘snot’), postnasal drainage (mucus dripping down the back of the throat from the back of the nose) and headaches. Pain is not usual but if present tends to indicate an additional bacterial infection of the sinuses. This infection is usually diagnosed using blood tests (to detect antibodies to the fungus), CT scan, endoscopy and culture of samples taken from the sinus. Nasal polyposis is often present (N.B. these are NOT cancerous even though they are described as tumours). This condition is usually treated with steroids and surgery. The steroids are usually continued for some time as reduction of inflammation inside the nasal passages and sinuses is important to allow natural drainage. Once drainage is optimised the inflammation usually subsides and eventually steroids can be slowly stopped.
Despite all these efforts patients relapse quite frequently and some doctors have tried treating with antifungal medication to try to eradicate the fungus. Results are confused so far – this is a subject for more research.
In exceptional cases the bones of the sinus can be perforated, allowing the fungus to invade neighbouring sites such as the eye.
Sinusitis is defined as inflammation of the paranasal sinuses, with or without infection. Inflammation can be caused by bacterial infection, allergy, virus and fungal infection. Frequently fungal infection is detected once the condition fails to respond to antibiotics designed to kill bacterial infections but which have no effect on fungal infections. Aspergillus sinusitis is thought to be caused by repeated bacterial infections causing swelling which restricts the normal drainage of the sinus. Treatment with antibiotics thus often produces a partial response as the bacteria die away and the swelling reduces and this must lead to many incomplete diagnoses. Symptoms are nasal congestion, facial discomfort, headache and postnasal drainage. Diagnosis is by CT scan, endoscopy (a tiny camera inserted into the sinuses) or quite frequently during surgery to improve drainage! Treatment is surgery to improve sinus drainage – a major contributing factor to getting the problem in the first place is a slightly different structure to the sinus which makes drainage less easy. Surgery corrects that fault. Antifungals are not normally used.
Sinusitis can be prone to reoccurrence but this is usually a successful procedure.