Non-surgical Management of Fungal Sinusitis

ABSTRACT

This article attempts to review the current understanding of non-surgical management of fungal rhinosinusitis. Fungal rhinosinusitis can be divided into an invasive or non-invasive form based on the clinical, radiologic, and histologic manifestations. For the proper management of acute fulminant invasive fungal sinusitis, antifungal medications, complete surgical debridement, and reversal of the underlying state of immune dysfunction are necessary. Antifungal medication and complete extirpation of the disease are required in the treatment of chronic invasive fungal sinusitis or granulomatous fungal sinusitis. Sinus fungal ball can be adequately treated through a complete surgical removal of the fungal ball and irrigation of the involved sinus. Post-operative antifungal therapy is rarely necessary unless the patient suffers from a compromised immune function. Treatment of an allergic fungal rhinosinusitis is marked by a high rate of recidivism. Earlier 'radical' surgery has currently been replaced with a combination of conservative surgery and medical therapy, including immunomodulation with corticosteroids or immunotherapy.