title: The changing face of paranasal sinus fungus balls.
abstract: OBJECTIVE
  We describe the clinical, radiographic, and histopathologic characteristics of fungus balls.
  
  
  METHODS
  We performed a retrospective review of 24 consecutive patients with the diagnosis of a paranasal sinus fungus ball (mycetoma) from 2001 to 2008.
  
  
  RESULTS
  We found that 18 of the 24 primarily involved sinuses had bony thickening, and 13 of the 24 had notable dilatation of the ostium. Eleven of the 24 patients were found to have some degree of immunocompromise (from organ transplantation, diabetes, etc). The patient's immune status correlated with the type of fungus involved. (Mucor-like fungi were more common in immunocompetent patients, and aspergillus-like fungi were more common in immunocompromised patients.) Also, there was a predilection for immunocompetent patients to have dilatated ostia, whereas immunocompromised patients were more likely to have a nondilatated ostium (p = 0.019).
  
  
  CONCLUSIONS
  Our series of paranasal sinus fungus balls defines a group of patients heretofore poorly described in the literature. Our data reveal an increased incidence in immunocompromised patients. We also found consistent radiographic patterns, correlations between immune status and the fungal pathogen, correlations between ostial enlargement and immune status, and the presence of cranial nerve pareses. These represent new findings that merit further study.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-1225, USA.
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Robey
authors.forename: Erin K
authors.initials: EK
authors.lastname: O'Brien
authors.forename: Brynn E
authors.initials: BE
authors.lastname: Richardson
authors.forename: John J
authors.initials: JJ
authors.lastname: Baker
authors.forename: David P
authors.initials: DP
authors.lastname: Poage
authors.forename: Donald A
authors.initials: DA
authors.lastname: Leopold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001228:Aspergillosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D025301:Hyphae; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology*; D055815:Young Adult