Fungus balls or Mycetoma can cause sinus pressure and bad breath. CT scan findings are fairly characteristic with hyperdensity. These “balls” are not invasive but need to be surgically removed. Intraoperatively, one finds thick clumps of ‘clay like’ or ‘cheesy’ material with a dark greenish black color. They can recur and affected patients therefore need to be monitored carefully for a prolonged period of time.

Allergic fungal sinusitis is a more diffuse form related to hypersensitivity to specific fungi in allergic individuals. They are often found with nasal polyps. CT scan will show opacified sinuses, hyperattenuation, and sometimes flecks of calcification. Intraoperatively, one finds thick ‘peanut butter’ like tenacious greenish black or brown debri. Medical and surgical treatments are required, along with consideration towards immunotherapy to prevent further recurrences.

Invasive fungal sinusitis is an aggressive destructive disease with vascular invasion. They can be caused by Mucormycosis or Aspergillosis. These infections occur in immunocompromised and diabetic patients. CT scan shows progressive soft tissue and bony destruction within the sinus cavities. Intracranial and orbital extension can also occur and patients require early aggressive treatment with Surgery and IV antifungal medications in view of the high mortality rate.