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Antibiotics Won't Cure Fungal Sinus Infections. Here's How to Treat Them

You’ve probably heard of sinusitis or sinus infections. Maybe you’ve had one yourself. They happen when your sinus cavities get inflamed—your face aches, your nose is stuffy or runny, and you might have a fever.

Most of the time, a virus like the one that causes colds causes sinusitis, and it clears up in 10 days or so. Sometimes, it’s bacteria that’s the culprit, and a course of antibiotics should have you feeling better.

But in other cases, it’s a fungus that’s infected your sinuses, so antibiotics won’t help. Mold, yeast and mildew are types of fungi, and you can breathe them in—that’s how they get into your sinuses. 

What can you do? Christopher Le, MD, an ear, nose and throat specialist with Banner - University Medicine, explained that our environment is full of fungi, so it’s common to have fungi in your nasal cavity and sinuses. Most of the time, your immune system keeps them from spreading. But sometimes, the fungi spread and cause sinusitis. 

Different forms of fungal sinusitis

Fungal sinus infections can be invasive or noninvasive. Noninvasive versions include:

  • Fungal ball, where fungus or mold collects in one or more of the sinus cavities. The balls eventually get big and block the sinuses.
  • Allergic fungal sinusitis (AFS), which is when you have an allergic reaction to fungus or mold. You’ll build up a lot of mucus, and you may form sinus polyps. 

Invasive versions are less common but more serious. They include:

  • Acute invasive fungal sinusitis (AIFS) is where the fungus or mold spreads through the blood vessels to the sinus tissue, bone and brain. These invasive infections progress quickly and cause symptoms such as facial numbness, blindness and if it reaches the brain, neurological deficits. It’s fatal 50% of the time, on average. It tends to strike people who have a compromised immune system such as people with  uncontrolled diabetes, people who are undergoing chemotherapy, organ transplant recipients and people with immunodeficiencies.
  • Chronic invasive fungal sinusitis (CIFS) is where the fungus or mold invades the tissue and bone but progresses slowly. It doesn’t cause many side effects or death, and it’s usually found in people with typical immune systems.
  • Granulomatous invasive fungal sinusitis (GIFS) is similar to CIFS but with specific changes in tissues and the types of people it affects. It’s usually found in people with typical immune systems in North Africa, the Middle East and Asia and can cause the eyes to protrude or be displaced.

What are the symptoms of a fungal sinus infection?

These diseases usually have symptoms such as:

  • Pressure or pain in the face
  • Headache
  • Nasal congestion or obstruction
  • Discolored nasal drainage
  • Foul-tasting postnasal drip

With allergic fungal rhinosinusitis, you may also have a reduced sense of smell or taste. With acute invasive fungal sinusitis, symptoms progress rapidly to fever, facial numbness, vision changes, altered mental status and weaknesses in the cranial nerve.

How to test for fungal sinus infection

If your doctor suspects fungal sinusitis, they will review your medical history and your symptoms, examine your head and neck, look at your nasal cavity and sinuses with a high-definition camera (called a nasal endoscopy) and assess your cranial nerves. 

You’ll likely need a CT scan of your sinuses, and an MRI exam if there are concerns that the fungus is invasive or may have reached the eye socket, eye or brain.

For allergic fungal rhinosinusitis, you may need allergy testing for mold. If your sinus infection doesn’t respond to antibiotics or if it lasts more than three months, you should see a specialist for further medical care, Dr. Le said.

What kills fungus in the sinuses?

For fungal sinusitis, you need surgery to remove the fungus. “Antifungal therapy will not treat fungal sinusitis without surgery,” Dr. Le said. The extent of surgery depends on what type of infection you have.

You'll need emergency surgery for acute invasive fungal sinusitis since this disease progresses quickly and is often life-threatening. Dr. Le recommends seeing a surgeon who received advanced training following their otolaryngology residency.

After surgery, you’ll need high-volume nasal and sinus irrigation to help keep your sinuses clean and make sure the fungus doesn’t reinfect. You may also need steroids, antibiotics for any bacteria identified during the surgery, antifungals if you have invasive fungal sinusitis, and allergy shots or immunotherapy for allergic fungal rhinosinusitis.

Can you prevent these infections?

“It’s difficult to prevent fungal sinusitis since fungi are found throughout the environment,” Dr. Le said. If you have diabetes, keeping it well-controlled can help reduce your risk. People who are undergoing chemotherapy or organ transplant can take antifungal medications to reduce the chance of acute invasive fungal sinusitis.

Is fungal sinusitis dangerous?

Sinus infections are usually caused by viruses or bacteria. But sometimes, it’s a fungus that’s the culprit. Fungal sinusitis needs to be treated with surgery and sometimes is serious.

Need help diagnosing and treating fungal sinusitis?

Schedule an appointment with a primary care provider.
Schedule an appointment with an ear, nose and throat specialist.

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