Most cases of sinusitis result from bacterial infection. Much less frequently, fungi cause the sinus infection. Since some aspects of clinical management depend on whether the causative agents are bacteria and/or fungi, it is important to be able to differentiate one from the other.

It is more likely for a person to have a bacterial, rather than a fungal sinus infection. The incidence of bacterial sinusitis is much higher because most healthy individuals are not susceptible to fungi that cause sinusitis. In fact, fungal sinusitis is quite common only to patients who are immuno-compromised (meaning their immune system is weak) due to some other illnesses like HIV-AIDS or cancer. Another possibility why fungal sinusitis happens is when a person is allergic to the fungi or mold that causes it. It is worth emphasizing that though fungal sinusitis is rare for most healthy individuals, the likelihood of developing this disease increases to a great extent if people are considerably exposed to an environment where fungi thrive. As such, periodically checking our homes and work places for seen and unseen fungi is not a waste of money but indeed, a wise health investment.

Spotting Fungal Sinusitis
Many of the manifestations associated with bacterial sinusitis are similar with those in fungal sinusitis. That is why a lot of fungal sinusitis could be misdiagnosed and treated as bacterial sinusitis. However, a doctor would most likely consider fungal sinusitis if:
- it is chronic in nature (signs and symptoms last for more than 12 weeks)
- the patient often experiences fever during the course of the infection
- and the infection is unresponsive to antibiotic treatment.

Fungal sinusitis can be confirmed with diagnostic imaging techniques like x-ray, CT scan or MRI.

There are four distinct types of fungal sinusitis: fungal ball, allergic fungal sinusitis,
acute invasive fungal sinusitis and chronic invasive fungal sinusitis.

A fungal ball is an overgrowth of fungal elements, which usually occurs in the maxillary sinus (found in the cheeks). Diagnostic imaging will reveal blockage of the affected sinus/es, but no damage to the surrounding bone. Allergic fungal sinusitis is the most common type of fungal sinusitis. Prominent manifestations include nasal polyps and thick nasal secretion.

The acute and chronic invasive types are the most serious, but least common types of fungal sinusitis. In acute invasive fungal sinusitis, the fungal elements rapidly grow deeply into the sinus tissues and bones. The mechanism involved in chronic invasive fungal sinusitis is also similar, but to a much slower pace. Examination of the nose may reveal mold spores and areas of necrosis.

Some medications, such as decongestants, that are used in the treatment of bacterial sinusitis may also be used for fungal sinusitis. If the doctor suspects that there is also a concomitant bacterial infection, antibiotics may also be prescribed. In addition, an anti-fungal medication is administered. Some of these medications are administered orally, while some through metered dose nasal sprays. Sinus Dynamics, one of the leading pharmaceutical companies specializing in sinusitis treatments, customizes the different types of sinusitis medications, including anti-fungals, in forms suitable for nebulization and medicated irrigation. They also have their own line of quality nebulizers and irrigators.

Fungal sinusitis requires a long course of treatment, and patient compliance is crucial for the success.

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