Irrigation Useful for Endoscopic Removal of Maxillary Fungus Balls

Powered saline irrigation reduces procedure time and complications in the endoscopic removal of fungus balls in maxillary sinuses, according to a new study.

Researchers at Far Eastern Memorial Hospital (Taipei, Taiwan) removed unilateral maxillary sinus fungus balls during functional endoscopic sinus surgery in 17 patients using the traditional method, and in 12 patients with the assistance of powered saline irrigation system; all procedures were performed between July 2009 and July 2011. The researchers then compared the duration, complication, and recurrence of extramucosal mycosis in the two procedures.

The researchers found that the fungus balls could be efficiently cleared in all maxillary sinuses. Mean duration for the traditional method group was 397 seconds, significantly longer than 155 seconds for the powered saline irrigation group. In the traditional method group, four patients (24%) developed focal maxillary mucosal detachment during the procedure, while one patient developed chronic bacterial maxillary sinusitis later, requiring a secondary endoscopic sinus surgery. Neither operative complication nor disease recurrence occurred during the follow-up period in the powered saline group. The study was published early online on December 7, 2012, in Clinical Otolaryngology.

“Our series confirms the efficacy of functional endoscopic sinus surgery in the treatment of maxillary fungus balls,” concluded lead author Wu Chia Lo, MD, and colleagues. “The assistance of powered saline irrigation provides more timesaving procedures and less postoperative complications.”

Paranasal sinus fungus balls (mycetomas) usually affect immune-competent people and are most frequently found in the maxillary sinuses. Endoscopic middle meatal antrostomy is the most popular approach to manage maxillary sinus fungus balls, used to completely remove the fungus balls in order to improve the aeration of the involved sinuses.

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