Analysis of clinical characteristics of fungus ball based on the number of involved sinuses.

Background: Fungus ball (FB) typically presents unilaterally, with the maxillary sinus being the most commonly affected site.Multi-sinus FB cases are seldom discussed.

Methodology: A retrospective study involving 1709 FB patients categorized them into single sinus fungus ball (SSFB), double sinus fungus balls (DSFB), and multiple sinus fungus balls (MSFB) groups for clinical analysis.

Results: The SSFB group comprised 1596 patients (93.39%), the DSFB group 111 patients (6.50%), and the MSFB group two patients (0.12%). The prevalence of diabetes mellitus in the DSFB group was higher than that in the SSFB group. A female prevalence was noticed and there was no difference in the sex ratio by age group. On computed tomography (CT), maxillary sinus FB group had higher intralesional hyperdensity than sphenoid sinus FB group. Oppositely, sphenoid sinus FB group had higher lateral sinus wall sclerosis than maxillary sinus FB group.

Conclusions: DSFB occurs in a minority of cases but needs to be investigated especially in diabetics given the link between diabetes mellitus and increased DSFB risk. A female predominance is seen in both pre- and postmenopausal women. On CT, the presence of intralesional hyperdensity and lateral sinus wall sclerosis correlates with the location of the FB.