Do You Need Surgery for Fungal Sinusitis? Exploring Treatment Options

Is surgery always necessary for the treatment of fungal sinusitis?

Dear Doctor: I am a patient with Systemic Lupus Erythematosus (SLE).
Recently, for about three to four weeks, I have been experiencing post-nasal drip in the early morning, producing thick yellow-green phlegm with streaks of blood.
The mucus from my left nostril is also yellow-green and contains blood and tissue-like fragments, but there is no foul odor.
Initially, I thought it was a cold, but later I was diagnosed with fungal sinusitis by an otolaryngologist.
After taking different types of antibiotics for 15 consecutive days, my symptoms have improved; I feel my nasal passages are clearer, with occasional small amounts of watery mucus, and the thick phlegm has decreased.
However, the doctor mentioned that fungal sinusitis is difficult to cure with medication alone.
Should I continue taking antibiotics, or should I consider surgical treatment? Is surgery necessary to cure fungal sinusitis? Thank you for your response.

Wen Ying, 50~59 year old female. Ask Date: 2020/07/02

Dr. Zheng Jueyi reply Otolaryngology

Hello, fungal sinusitis is indeed difficult to treat with medication.
General antibiotics primarily target bacterial infections.
If two weeks of antibiotics do not resolve the issue, surgical treatment is recommended.
Wishing you safety and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2020/07/02

More Info

Fungal sinusitis, particularly in patients with underlying conditions such as systemic lupus erythematosus (SLE), can present unique challenges in treatment. Your symptoms, including the yellow-green phlegm with blood streaks and the diagnosis of fungal sinusitis, indicate a significant infection that may not respond adequately to standard antibiotic treatments, which are primarily effective against bacterial infections.

In general, the treatment for fungal sinusitis can vary depending on the type of fungal infection and the patient's overall health. There are two main types of fungal sinusitis: invasive and non-invasive. Non-invasive fungal sinusitis, such as allergic fungal sinusitis, may respond to medical management, including antifungal medications and nasal irrigation. However, invasive fungal sinusitis, which is more serious and can occur in immunocompromised patients, often requires surgical intervention to remove infected tissue and improve drainage.

In your case, since you have been on antibiotics for 15 days with some improvement in symptoms, it suggests that there may be a mixed infection or that the fungal component is not fully addressed by antibiotics alone. While antibiotics can help with secondary bacterial infections, they are not effective against fungal pathogens. Therefore, continuing antibiotics without addressing the fungal infection may not lead to complete resolution of your symptoms.

Surgery is often recommended for patients with fungal sinusitis when medical management fails or when there is evidence of significant obstruction or tissue damage. The surgical procedure, typically functional endoscopic sinus surgery (FESS), aims to remove fungal debris, improve sinus drainage, and allow for better access to the sinuses for further treatment. This approach can be particularly beneficial if there is a risk of complications or if the infection is causing significant discomfort or functional impairment.

In your situation, it is crucial to have a thorough discussion with your ENT specialist regarding the potential need for surgery. They may consider factors such as the extent of the infection, your overall health, and how well you are responding to current treatments. If surgery is deemed necessary, it can provide a more definitive solution to the infection and help prevent recurrence.

In addition to surgical options, adjunctive therapies such as saline nasal irrigation can help keep the sinuses clear and reduce inflammation. Some studies have suggested that using topical antifungal agents, such as Bactroban (mupirocin), in nasal rinses may help in certain cases, but this should be done under the guidance of a healthcare professional.

In conclusion, while surgery is not always necessary for fungal sinusitis, it may be the best option for you given your symptoms and the difficulty in treating fungal infections with medication alone. It is essential to work closely with your healthcare team to determine the most appropriate treatment plan tailored to your specific needs and health condition.

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