From the Guidelines
Fungal sinusitis requires prompt and aggressive treatment, with the specific approach depending on the type of fungal infection, and I strongly recommend immediate hospitalization and IV antifungal therapy for invasive fungal sinusitis, as well as surgical debridement and long-term antifungal therapy for chronic indolent fungal sinusitis. The treatment of fungal sinusitis depends on the type of infection, with allergic fungal sinusitis typically managed with nasal corticosteroids (such as fluticasone 50mcg, 1-2 sprays per nostril daily) and oral steroids (prednisone 0.5-1mg/kg/day for 1-2 weeks with taper) 1. In contrast, invasive fungal sinusitis requires immediate hospitalization and treatment with IV antifungal therapy (amphotericin B 5-10mg/kg/day) and surgical debridement, as highlighted in the European position paper on rhinosinusitis and nasal polyps 2020 1.
For chronic indolent fungal sinusitis, a combination of surgery and long-term antifungal therapy (itraconazole 200mg twice daily for 3-6 months) is typically necessary, as noted in the ACR appropriateness criteria for sinonasal disease: 2021 update 1. It is essential to maintain good humidity control at home, use saline nasal irrigation (240mL twice daily), and complete the full treatment course even after symptoms improve. Fungi thrive in moist environments and can cause persistent inflammation in the sinuses, with Aspergillus and Mucor species being common culprits. Immunocompromised patients are at higher risk for invasive forms and require more aggressive management.
Key considerations in the treatment of fungal sinusitis include:
- The need for prompt and aggressive treatment, particularly for invasive fungal sinusitis
- The importance of surgical debridement and long-term antifungal therapy for chronic indolent fungal sinusitis
- The use of nasal corticosteroids and oral steroids for allergic fungal sinusitis
- The need for good humidity control and saline nasal irrigation to prevent fungal growth and promote healing
- The high risk of invasive fungal sinusitis in immunocompromised patients and the need for aggressive management in these cases.
From the Research
Fungal Sinusitis Treatment
- The treatment of fungal sinusitis can be challenging, especially in immunocompromised patients 2.
- Surgery is often the main treatment, with antifungal medications used as adjuvant therapy 2, 3.
- Liposomal amphotericin B has been shown to be an effective alternative to conventional amphotericin B, with less nephrotoxicity and infusion-related reactions 2.
- Voriconazole has also been found to be effective in treating chronic invasive fungal sinusitis, with some studies suggesting it may be more effective than itraconazole and amphotericin B 4, 3, 5.
Types of Fungal Sinusitis
- Acute invasive fungal sinusitis (AIFS) is a serious and potentially life-threatening condition, often affecting immunocompromised patients such as those with cancer or transplant recipients 6.
- Chronic granulomatous fungal sinusitis (CGFS) is a rare form of invasive fungal sinusitis, with Aspergillus flavus being the most commonly isolated fungus 4.
- Chronic invasive fungal sinusitis can be treated with a combination of surgery and antifungal medications, such as voriconazole 3, 5.
Antifungal Medications
- Amphotericin B is a commonly used antifungal medication, but its use can be limited by dose-related nephrotoxicity and infusion-related acute toxicity 2.
- Itraconazole and voriconazole are also used to treat fungal sinusitis, with voriconazole showing promise as a more effective treatment option 4, 3, 5.
- Liposomal amphotericin B is recommended as an empiric therapy for AIFS, with targeted therapy initiated once a fungal pathogen is identified 6.