There are two primary types of invasive fungal sinus infections—acute and chronic. The acute version is more serious and primarily occurs in people whose immune systems have been compromised. Fungi usually feed on dead organic matter, but weakened immune defenses can allow fungi to begin eating tissue that is still alive. As the fungus reproduces it spreads rapidly into the blood vessels, eye area, and central nervous system with devastating results. Acute invasive fungal sinusitis is a rare condition with a high mortality rate.
Fungal infection of the sinuses can occur when fungal organisms are inhaled and deposited in the nasal passageways and paranasal sinuses, causing inflammation. The dark, moist environment of the sinuses is ideal for fungi, which can reproduce without light or food. Most fungal infections of the sinuses are noninvasive, meaning they won't spread to surrounding tissue.
Symptoms are similar to a sinus infection—congestion, facial pain and swelling, and discharge—but you may be severely ill with these symptoms.
The preferred treatment at UPMC for treating invasive fungal sinusitis is the Endoscopic Endonasal Approach (EEA). This innovative technique involves using the nose and nasal cavities to remove the infected tissue in the sinuses. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a shorter recovery time.
Your physician will ask about any symptoms you have been having. People with invasive fungal sinusitis usually are very ill, and may have some of the following symptoms:
- facial pain or numbness
- facial swelling
- nasal discharge
- mental status changes
- dark ulcers within the nasal canal or on the roof of the mouth
- visual disturbances
Those with chronic invasive fungal sinusitis usually have symptoms of a long-standing sinus infection. These include congestion, drainage, and pressure in the forehead, nose, and behind the eyes. Orbital apex syndrome is also characteristic of the chronic infection. Its symptoms include decreased vision and ocular immobility, due to a mass of fungal material that has spread into the eye orbit.
Acute invasive fungal sinusitis is a medical emergency, and surgery to remove the infected tissue should be performed immediately once the diagnosis is made. Radical removal of all dead and infected tissue is necessary. The chronic infection requires surgery as well.
Invasive fungal sinusitis may be approached directly by using the Endoscopic Endonasal Approach (EEA). This approach allows surgeons to see and access the area well without making incisions to the face or skull. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a shorter recovery time.
Treatment also includes follow-up with antifungal medications. Patients with invasive fungal sinusitis need to remain under long-term observation by a physician, as recurrence is common.