Caseous Rhinosinusitis: Fungal or Bacterial Ball?

Background The fungal ball is a common type of fungal rhinosinusitis. The fungal ball appears to be unstructured caseous masses revealed during the surgical treatment. Aim and objective To analyze the contents of the paranasal sinuses in 168 patients with the clinically suspected fungal ball who had undergone functional endoscopic sinus surgery (FESS). Study design A total of 168 patients aged between 19 and 63 with fungal ball clinical diagnosis admitted to the ENT Department of Rostov State Medical University, Russia, were involved in the study between January 2009 and July 2018. Materials and methods Tissue samples obtained from the affected sinuses underwent microscopic, microbiological, and histopathological examination. Results Fungi presence was confirmed in 148 out of 168 patients. In 20 cases, the presence of fungi in the caseous masses, obtained during the operation, was not revealed by any diagnostic method, and in 19 out of 20 patients, different types of bacteria were detected in diagnostically significant titers, most often Bacteroides spp.—in five patients, Staphylococcus spp.—in five patients, Pseudomonas aeruginosa —in three patients, two cases of Klebsiella pneumoniae , and two cases of Actinomyces spp. To characterize such findings, the term “bacterial ball” by analogy with the “fungal ball” was earlier suggested. Conclusion Caseous masses found during sinus surgery is often considered to be a clinical diagnosis validation. Meanwhile, the said caseous masses may not only manifest a fungal disease, but also bacterial colonization, which determines the postoperative treatment. How to cite this article Boiko NV. Caseous Rhinosinusitis: Fungal or Bacterial Ball? Int J Otorhinolaryngol Clin 2019;11(3):64–66.