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Comprehensive management of paranasal sinus fungus balls: A Young‐IFOS consensus statement
Author(s) -
Saibene Alberto Maria,
Allevi Fabiana,
CalvoHenriquez Christian,
Dauby Nicolas,
Dondossola Daniele,
Hervochon Rémi,
Lechien Jérome R.,
LoboDuro David,
Locatello Luca Giovanni,
Maniaci Antonino,
Mannelli Giuditta,
MayoYáñez Miguel,
MazaSolano Juan,
Radulesco Thomas,
Tan Neil,
Tincati Camilla,
Tucciarone Manuel,
Vaira Luigi Angelo,
Sowerby Leigh
Publication year - 2023
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.23093
Subject(s) - medicine , statement (logic) , consensus conference , sinus (botany) , law , political science , botany , biology , genus
Abstract Background Paranasal sinus fungus balls (PSFB) are a common form of surgically treatable, noninvasive mycosis. To date, no guidelines have standardized PSFB treatment or management of difficult cases (eg, immunocompromised or fragile patients). The clinical consensus statement presented herein aims to provide a comprehensive management guide to PSFB based on current evidence. Methods A multidisciplinary, international panel of 19 specialists judged statements in 3 rounds of a modified Delphi method survey. Statements encompassed the following PSFB management issues: definition, diagnostic workup; treatment indications and modalities; and follow‐up. Otolaryngologists, maxillofacial surgeons, infectious disease specialists, and transplant physicians were considered the target audience. Results Among the 23 statements, 7 reached strong consensus and 16 reached consensus. Consensus was reached on the definition, diagnosis, and treatment modalities for PSFB. Postoperative follow‐up modalities and scenarios with bacterial superinfection were the most debated issues. Conclusion Until further data are available, these points provide a framework for the management of PSFB. Moreover, PSFB should be considered a noninvasive mycosis that is not necessarily symptomatic or related to odontogenic conditions. Although diagnosis may be incidental, endoscopy and single imaging (computed tomography or magnetic resonance imaging, with distinctive features) are required for diagnosis, whereas contrast medium would allow for differential diagnosis. Although treatment of PSFB should be considered mandatory before sinus augmentation and is recommended for symptomatic patients, immunosuppressed patients, or patients with planned immunosuppression, watchful waiting could be considered for asymptomatic patients with chronic rhinosinusitis who are provided with appropriate advice and assessment.