Is a fungus the cause of persistent sinus problems? (Fungal Sinusitis) Let's find out for sure!

Do you also often have sinus problems? Is it normal to have a stuffy, stuffy nose, a headache, and sore cheeks and forehead? Many of us call this "sinusitis." But did you know that sometimes the cause of this sinus problem is not a normal germ (bacteria), but a fungus (fungus). That is what we call Fungal Sinusitis, or Fungal Rhinosinusitis in medicine. Today, we will talk about this simply, in a way that you can understand.

Simply put, what is Fungal Sinusitis?

Okay, first let's look at what sinuses are. Sinuses are the empty air cavities inside the bones of your face, around your nose. These are connected to your nose. Normally, these cavities are filled with air.

Now imagine, if a fungus - a type of mold- gets into these sinus cavities and causes an infection, that's what we call Fungal Sinusitis . Just like mold grows on a piece of bread, fungi can grow inside our sinus cavities. This causes symptoms like nasal congestion and sinus pain.

There are two main types of Fungal Sinusitis:

It is very important to understand this precisely, because while one type is usually not dangerous, the other type can be life-threatening.

1. Noninvasive type: This is the most common type. Here, the fungus is confined to the nose and sinus cavities. It's like mold growing on a wall in a house, but it doesn't break through the wall and spread into the house. This type is less dangerous.

2. Invasive type: This is the most dangerous type. Here, the fungus destroys the walls of the sinus cavities and begins to spread to surrounding tissues, the eyes, and even the brain. Just like that mold that grew on the wall, ate away at the wall and spread throughout the house. This can be fatal if not treated quickly.

Now let's look at the subdivisions under these two types in a little more detail.

Noninvasive types

• Allergic Fungal Sinusitis: This is when your body has an allergic reaction to a fungus that enters your nose. This causes the sinus cavities to fill with thick mucus, and sometimes causes things like nasal polyps to form. People with asthma or allergies to things like dust mites (allergic rhinitis) are more likely to develop this condition.
• Fungal Ball (Mycetoma): This is when fungi form a ball-like mass inside a sinus cavity. As this ball of fungus grows, it can block the sinus cavity, causing pressure and pain.
• Saprophytic Fungal Sinusitis: This is when fungi grow on dry mucous membranes (crusts) inside the nose. This usually doesn't cause much harm.

Invasive species - these are the dangerous ones!

• Acute Invasive Fungal Sinusitis: This is a very sudden and severe condition. Here, the fungus destroys the blood vessels inside the nose. As a result, the tissue begins to die. This infection can spread very quickly to the eyes and brain, causing blindness and even death. People with weakened immune systems (e.g., cancer patients, HIV-infected people) are at higher risk of developing this condition.
• Chronic Invasive Fungal Sinusitis: This is similar to the Acute type mentioned above, but the rate of spread is a little slower. It spreads slowly over time. People with diabetes are more likely to develop this type.
• Granulomatous Invasive Fungal Sinusitis (GIFS): This is a very rare type. What happens here is that the body's immune system mounts a severe response against the fungus, destroying the tissues of the nose. It is not yet known exactly why this happens.

Who is more likely to get these fungal sinus infections?

Generally, healthy people rarely develop these fungal infections, especially the dangerous invasive types. However, people with weakened immune systems are at a much higher risk. For example:

• For those infected with HIV
• Cancer patients (especially leukemia, lymphoma) and those undergoing chemotherapy
• For those with severe uncontrolled diabetes
• People taking medications such as immunosuppressants and steroids for a long time (e.g. organ transplant patients)

What are the symptoms of Fungal Sinusitis?

The symptoms are very similar to those of a common sinus problem. However, additional symptoms may occur depending on the type of infection and whether it is aggressive or not. Let's look at these in a table.

How do you accurately diagnose this disease?

When you see a doctor, he will first ask you about your symptoms, any other illnesses you have, and any medications you are taking. Then, he may run several tests to confirm the diagnosis.

• Endoscopy: This involves inserting a thin tube with a camera into the nose to examine the inside of the sinus cavities. This allows the condition inside the sinuses to be seen on a monitor.
• Biopsy: During the endoscopy, the doctor may take a small sample of mucus or tissue from inside the nose or sinus cavity and send it to the lab for testing. This test can tell for sure whether the infection is caused by bacteria, a virus, or a fungus. It can also determine if the infection is invasive.
• CT Scan: This is an imaging test similar to an X-ray. It can produce three-dimensional images of the inside of the sinus cavities. This can help to clearly see how far the infection has spread and whether there are any fungal balls.

What are the treatments for this?

The treatment method depends on the type of fungal sinusitis you have and the condition of your immune system.

• Sinus Surgery: This often requires surgery. The surgery involves removing all infected tissue, fungal balls, and thick mucus, and thoroughly cleaning the sinus cavities. In invasive cases, the surrounding tissue may also need to be removed.
• Antifungals: For some types of infections, especially invasive types, antifungal medications (oral or injectable) are given at the same time as surgery.
• Corticosteroids: Steroids (nasal sprays or pills) can be given to reduce swelling and pressure in the sinus cavities. These are most commonly used for Allergic Fungal Sinusitis.
• Nasal Wash: In simple cases, such as the saprophytic type, the dried mucus inside the nose is removed and the sinus cavities are cleaned with a saline solution.

What happens after treatment?

Noninvasive types: These usually resolve completely with treatment, but some types (especially Allergic Fungal Sinusitis) may recur after treatment.

Invasive types: These are very dangerous. In severe infections like Acute Invasive Fungal Sinusitis, the risk of death is about 50% even with prompt treatment. That is why it is recommended to see a doctor as soon as possible, even if you have minor symptoms. Even if your life is saved after treatment, some people may suffer nerve damage and facial deformities (due to tissue removal).

When should I see a doctor? When should I go to the ETU?

• If you have the symptoms of Fungal Sinusitis mentioned above, especially if they have been present for a long time (Chronic Sinusitis), be sure to see a doctor for a checkup.
• If you have previously had fungal sinusitis or have a disease that lowers your immune system, always discuss it with your doctor.

Go to the Emergency Treatment Unit (ETU) immediately!

If you are immunocompromised (e.g., cancer patient, HIV infected, immunosuppressant) and you develop any of the symptoms of an invasive infection (such as facial numbness, eye swelling, vision changes), go to the nearest hospital emergency room (ETU) without delay. This can be a life-or-death situation.

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