Fungal colonization of the paranasal sinuses

Fungal infection of the paranasal sinuses occur in four primary types: acut e invasive (1), chronic invasive (2), chronic fungus ball (3) and allergic fungal sinusitis (4). The first and second form can be fatal and is often f ound in immunosuppressed patients. The present paper concerns a group of im munocompetent patients with non-invasive chronic sinusitis caused by moulds . Over the period from 1994 to 1998, 132 tissue samples from the paranasal si nuses obtained by endoscopic operation from 117 patients was examined for m ycotic infections. The mycological examination was carried out if granuloma tous and crumbly material was seen in the sinus by endoscopy (91 times maxi llary sinus, 23 times ethmoid sinus, 11 times frontal sinus, 7 times spheno id sinus). Out of 117 patients 29 were positive (24,9 %). From 132 surgical specimens fungi were proved in 34 times (25,7 %). The following fungal spe cies were isolated: Aspergillus fumigatus 17 times, other Aspergillus spp 6 times, Alternaria alternata 2, Penicillium rugulosum 1, and moulds without differentiation 5 times. In the histological examination an invasive mycel ial growth in the mucous membrane or in the bones was never observable. Our findings represented a commensal colonization of the paranasal sinuses, bu t not a mycosis. The colonization is evidently assisted by a chronic hypert hrophic sinusitis with increased mucus production which impedes the mucocil iary clearance. For immunosuppressed patients, however, this situation caus es a danger of invasion with fatal consequences.