Fungal sinusitis: symptoms and treatment in adults

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Green Elena Stanislavovna

Otolaryngologist of the second category

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Sinusitis is inflammation of the maxillary sinuses or maxillary sinuses (one of the types of sinusitis). Pathology can be caused by pathogenic bacteria, viruses, and fungi.

Fungal sinusitis occurs in approximately 10% of cases of general morbidity and occurs when, for some reason, opportunistic fungi living on the mucous membrane begin to multiply uncontrollably and rapidly in the maxillary sinuses. The disease occurs under certain circumstances and a weak immune system.

The risk group includes patients suffering from severe forms of diabetes, cancer patients who have undergone chemotherapy, HIV-infected people, and asthmatics. The disease can develop after unsuccessful dental procedures and injuries to the bones of the nasal septum and nearby organs.

Types of fungi that cause sinusitis

Fungal sinusitis is most often caused by mold and yeast-like fungi of the genus Candida Candida, Aspergillus Aspergillus fumigatus, niger.

The disease can also be caused by other types of fungi, such as:

• Mucoraceae;
• Penicillium;
• Bipolaris;
• Exserohilum;
• Fusarium;
• Helminthosporium;
• Drechslera;

How to treat fungal sinusitis depends on its form. The disease can have invasive and non-invasive forms. In the first case, it occurs much less frequently in patients with severe immune disorders.

The non-invasive form can develop in a person with normal immunity and can be of two types:

• mycetoma, which is a fungal ball;
• chronic allergic fungal sinusitis.

Fungal sinusitis treatment should begin at the first suspicion and strictly follow the doctor’s recommendations. Therapy drugs can only be prescribed as concomitant treatment. The main treatment is surgery.

Concept (code)

The maxillary sinuses are covered inside with muconasal secretion, which prevents viruses and bacteria from entering the body. The secreted mucus leaves the nasal cavity through the anastomosis, which is normally about 5 mm.

With this size of the anastomosis, the secretion flows out freely without accumulating in the sinuses. However, during inflammation, the mucous membrane swells and the size of the anastomosis decreases. As a result, mucus begins to accumulate in the maxillary openings, which contains a huge amount of viruses and bacteria. In the medical literature, maxillary sinusitis is assigned a code according to ICD 10.

Causes of maxillary sinusitis:

• Persistent runny nose;
• Anatomical features of the structure of the nasal septum;
• Adenoids, polypous neoplasms;
• Weak immunity, as a result of which a person suffers from frequent viral diseases;
• Inflammatory process in the oral cavity;
• Frequent hypothermia;
• Allergic reaction to internal and external irritants.

Symptoms of fungal sinusitis

Fungal sinusitis has symptoms both common with other types of sinusitis and different, characteristic only of fungal forms. Sometimes the disease remains asymptomatic for a long time.

Common symptoms include:

• breathing disorder;
• swelling of the mucous membrane;
• headache;
• impaired sense of smell.

The presence of a fungal form is indicated by specific secretions. By their appearance and consistency, you can determine the type of fungi that caused the disease. So, with non-purulent thick yellow discharge, one can suspect sinusitis caused by Aspergillus fungi. Transparent yellowish and jelly-like discharge occurs when affected by the mold fungus Penicillin, in the form of cottage cheese - by Candida mushrooms.

When affected by mycetoma, specific symptoms will be:

• pain in the area of ​​the upper jaw and the teeth located in this area;
• foul-smelling nasal discharge, bloody discharge.

About allergic fungal sinusitis we can talk about:

• with a feeling of fullness in the maxillary sinus;
• when mucus and blood are discharged from the nose;
• with the formation of polyps in the nasal cavity.

This type of sinusitis is accompanied by numerous allergic reactions.

Invasive fungal sinusitis is often characterized by rapid development of the disease and, in the absence of immunity, is accompanied by:

a sharp increase in temperature to significant levels;

• severe headache;
• visual impairment;
• breathing problems;
• copious discharge of blood from the nose.

Upon examination, cyanosis of the mucous membrane is detected. X-ray examination, carried out in two projections, gives a clear picture of the diagnosis, which is complemented by laboratory tests.

Causes of the disease

Many fungal organisms live in the air. They penetrate through the nose into the respiratory tract and settle in the maxillary sinuses. With weak immunity, they begin to multiply there, eventually forming sinusitis.

There are two forms of the disease:

1. Invasive, manifests itself in people with serious illnesses: diabetes mellitus, AIDS, the presence of oncology (including leukemia), receiving chemotherapy.
2. It is non-invasive and can occur in anyone.

The second form is often found among people with a cold. The nasal mucosa swells, the sinuses become clogged due to the development of fungus.

Fungal sinusitis can appear for various reasons. Risk factors for developing fungal disease are:

Nose trauma is one of the causes of fungal sinusitis

• taking antibiotics for a long period;
• the presence of foreign bodies in the nasal sinuses;
• hormonal imbalance;
• persistent illnesses: rhinitis, runny nose;
• nasal injury;
• allergic runny nose.

Signs of fungal sinusitis: nasal mucus turns brown, pain in the sinuses intensifies. It is worth noting that the disease progresses slowly, and a person may not be aware of sinusitis. The types of fungal infections are distinguished by nasal discharge. Jelly-like yellow mucus indicates mold; with candidiasis it is white.

The inflammatory process of the maxillary sinuses most often occurs in countries with a temperate, humid climate. In its advanced form, the disease is chronic and can cause complications such as otitis media and meningitis.

Treatment of bilateral sinusitis is carried out mainly with the help of folk and pharmaceutical remedies, but in severe cases - only with surgery. Many patients wonder whether it is possible to go to the pool with sinusitis; read the answer from an expert in our material.

How to treat fungal sinusitis

Treatment of fungal sinusitis should not be delayed. Once the diagnosis is made, treatment begins immediately. Treatment is carried out using surgery.

There are several methods of performing the operation:

• maxillary sinusotomy (performed under general anesthesia, intervention occurs from the oral cavity), is traumatic, can have a lot of complications);
• rhinotomy (also performed under general anesthesia, on the outside of the face, is traumatic, leaves cosmetic defects);
• endoscopy.

The endoscopic method is the most gentle. At the same time, it perfectly cleanses the maxillary sinuses from pathogenic contents. This method does not leave cosmetic defects, is not fraught with complications, and does not damage bones. During endoscopy, a small diameter puncture is made into which the endoscope is inserted.

During the operation, the mycetoma, or mucus (non-invasive form) is removed; excision of dead tissue is performed (invasive form). Then therapy with antimycotic drugs is prescribed, which are taken orally. In the final stages of recovery, additional therapy with folk remedies is possible.

Treatment

Treatment is usually carried out by an allergist, mycologist or ENT specialist, depending on the type of disease and its course. Initially, it is necessary to contact an ENT specialist or an allergist; if the disease is fungal in nature, the patient will be redirected for further treatment to a mycologist.

If the allergen is not identified, then allergic sinusitis cannot be treated; you can only alleviate the patient’s condition with the help of medications - antihistamines. Treatment of any allergy is the identification and complete elimination of the allergen from life.

Drug treatment

To treat fungal sinusitis after surgery, hormonal drugs (corticosteroids) that suppress the growth of fungi, immune stimulants and modulators, and antifungal drugs are prescribed.

After the operation, medications are prescribed such as:

• Irunin;
• Ketoconazole;
• Lamisil;
• Flucostat;
• Miramistin;
• Fluconazole;

Echinacea-based preparations are used to strengthen the immune system.

After the operation, diagnostics are carried out once a month for a year to prevent relapse of the disease.

Diagnosis and treatment

Difficulty in diagnosis - the disease is not always clearly visible on x-rays of the maxillary sinuses. In most cases, a specialist is contacted already in the later stages of fungal development, which facilitates the choice of research methods. The main way to determine pathology is to study the secreted mucus and CT scan. The main task of differential diagnosis is to exclude polyps and malignant neoplasms in the maxillary sinus.

An endoscope is used during the procedure. It is a thin tube with a camera and a light source at the end. It is inserted into the sinus of the nose, and the image is displayed on a computer monitor. Endoscopy allows you to assess the size of the mycetoma, its location and the degree of damage to the paranasal cavity. In addition, during the procedure, you can additionally take tissue samples for further study in the laboratory. The examination may cause discomfort to the patient; local anesthesia is sometimes used. Diagnostic time is 15-30 minutes.

Microbiological

Fungal spores are diagnosed using laboratory methods only when there is significant growth. In the early stages, the disease is extremely difficult to detect without tissue biopsy. For microbiological examination, nasal secretions and mycetoma particles obtained during endoscopy are used. The analysis allows you to accurately determine the type of pathogen, which is important for prescribing drug treatment. When studying, various microbial diseases of the sinuses and the malignant nature of the neoplasm are excluded.

Find out why a maxillary sinus cyst occurs here.

Reliable and informative diagnostic method. Its effectiveness is due to the appearance of the mycetoma at a late stage. Unlike polyps and cancer cells, mycosis has a high density, comparable to metal. When the image is displayed on a tomograph, you can notice a voluminous spherical mass with minor structural changes.

If you suspect sinusitis, you should urgently contact an otolaryngologist. After collecting medical history data, the following clinical examination methods are recommended to make a final diagnosis:

• X-ray of the sinuses;
• CT;
• Ultrasound of the nasal sinuses;
• Mycological examination in laboratory conditions.

So, complex treatment of fungal sinusitis has the following features:

1. Local use of antifungal drugs - ointments, drops, gels or squirts for the rapid and productive destruction of pathogenic flora. These are medications such as Fluconazole, Amphotericin B, Ketoconazole, Ketoconazole, Itraconazole, Terbinafine, Nystatin.
2. Oral administration of immunostimulants to activate the immune response of a weakened body and strengthen the organic resource. These are the medications Immunorix, Anaferon, Immunal, Imudon, Arbidol, Echinacea.
3. Local use of glucocorticosteroids to eliminate increased swelling of the nasal mucosa and reduce the intensity of symptoms of sinusitis. Particularly effective are medications such as Avamis, Nasonex, Flixonase.
4. Taking antihistamines to relieve general well-being and nasal congestion. Tablets such as Loratadine, Supradin, L-Cet, Cetrin, Zirtek, Tavegil, Suprastin, Desloratadine have proven themselves well.
5. Taking general strengthening drugs of plant origin. As an option - tincture of rosehip, aralia, ginseng, leuzia.
6. The presence of intensive vitamin therapy in the complex treatment regimen is mandatory, for example, you can take the multivitamin complexes Duovit, Complivit, Alphabet, Pikovit and others internally.

The patient must understand that treatment of a fungal infection is long and not always successful. Therefore, you have to be patient, strictly follow all medical recommendations, not engage in superficial self-medication and believe in a speedy recovery.

To establish a correct diagnosis, the first step is to culture the contents of the sinus for fungi, as well as how susceptible they are to antifungal drugs. An ENT doctor (or mycologist) also studies the anamnesis and examines the contents of the maxillary sinus (a puncture is performed).

Appointed:

• X-ray;
• Ultrasound of the nasal sinuses;
• sometimes computed tomography.

The color range of mushrooms ranges from black to green, sometimes white, and the smell is definitely unpleasant. When washing waters are examined, fungal mycelium is a frequent guest in them.

Treatment at home

Speaking about treatment at home, I would like to once again emphasize that fungal sinusitis is a dangerous disease and self-medication is fraught with serious complications, including death. Under the supervision of a doctor, in the final stages of treatment, solutions prepared according to the following recipes can be used to rinse the nose:

1. propolis and salt (15 drops +1 teaspoon + glass of water);
2. iodine and salt (2 drops + 1 teaspoon + glass of water);
3. carrot and beet juice mixed with saline solution (proportion 1:1:1);
4. a solution of salt and soda (1 teaspoon + 1 teaspoon + glass of water).
5. It is advisable to use sea salt. It is possible to use pharmacological saline solutions (Aquamaris, Humer)

Inflammation and swelling will be well relieved by infusions of medicinal herbs: sage, chamomile.

You can use nasal drops based on the same ingredients, and in addition to them you can use aloe juice, honey, and onions. These components are always used to treat sinusitis.

To prevent disease and improve immunity, take tincture of rose hips, eleutherococcus, echinacea, and ginseng.

You should be reminded of the need to take multivitamins and a balanced diet. A healthy lifestyle and reasonable physical activity will contribute to strengthening the immune system.

Diagnosis of the disease

To prescribe the necessary therapeutic course, the patient must be carefully examined. Only based on the diagnostic results, the doctor prescribes treatment that will help get rid of the disease.

1. Questioning the patient, collecting the necessary information about the onset of the disease, symptoms and possible causes of maxillary sinusitis.
2. Rhinoscopy. Using a special device, a rhinoscope, the condition of the mucous membrane in the nasal cavity, the abundance of secretion, the presence of various neoplasms in the nose, and the structural features of the nasal septum are revealed.
3. Laboratory research. A general blood test will determine the presence of an inflammatory process in the body, and a study of muconasal secretions will show the presence of viruses or bacteria in the mucus.
4. Radiography. The most popular method of studying the paranasal space, which allows you to determine the completeness of the inflammatory process, the amount of mucus accumulated in the sinuses, and the presence of polyps in the nose. ,
5. CT scan. Based on the diagnostic principle, computer examination is an alternative to radiography, but only a more expensive option.
6. Ultrasound examination of the paranasal sinuses. An ultrasound shows how much the sinuses are filled with mucus and whether the nasal septum is deviated. This method is less informative compared to MRI and X-ray, but has no contraindications for its use.
7. Diagnosis using an endoscope. Endoscopic examination is performed extremely rarely for maxillary sinusitis, and is used only in some medical institutions.

The sooner the patient’s ENT organs are diagnosed, the more effective the treatment will be.