Fungal Diseases of the Paranasal Sinuses

Arsen Koshtoyan; Vilen Azizyan; Lyusi Petrosyan; Yuri Ghukasyan; Avetis Kirakosyan

doi:doi:10.11648/j.ijo.20261201.11

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Fungal Diseases of the Paranasal Sinuses

Arsen Koshtoyan, Vilen Azizyan, Lyusi Petrosyan^*, Yuri Ghukasyan, Avetis Kirakosyan

Published in International Journal of Otorhinolaryngology (Volume 12, Issue 1)

Received: 17 January 2026 Accepted: 31 January 2026 Published: 11 February 2026

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Abstract

Fungal rhinosinusitis comprises a heterogeneous group of diseases affecting the nasal cavity and paranasal sinuses, ranging from non-invasive colonization to rapidly progressive, life-threatening invasive infections. The clinical course and prognosis largely depend on the host immune status and the presence of tissue invasion, with invasive forms posing a high risk of orbital and intracranial complications. In recent years, the incidence of fungal rhinosinusitis has increased, likely due to improved diagnostic modalities, wider use of endoscopy, and a growing population of immunocompromised patients, including those with diabetes mellitus and post-COVID-19 conditions. This article provides a comprehensive review of fungal rhinosinusitis, focusing on current classification, epidemiology, pathophysiology, clinical manifestations, diagnostic strategies, and management principles. According to histopathological criteria, fungal rhinosinusitis is classified into non-invasive forms (saprophytic colonization, fungal ball, and allergic fungal rhinosinusitis) and invasive forms (acute invasive, chronic invasive, and granulomatous invasive fungal rhinosinusitis). Non-invasive disease typically affects immunocompetent individuals and is characterized by localized fungal accumulation or hypersensitivity reactions without tissue invasion, whereas invasive forms predominantly occur in immunocompromised patients and are associated with angioinvasion, tissue necrosis, and bone destruction. Diagnosis relies on a combination of clinical evaluation, endoscopic findings, radiologic imaging, and definitive histopathological confirmation. Computed tomography plays a key role in identifying hyperdense fungal material and bony changes, while magnetic resonance imaging is essential for assessing soft-tissue involvement and extrasinus extension. Management strategies vary according to disease type and include surgical intervention, systemic antifungal therapy, and correction of underlying predisposing factors. A clinical case of isolated sphenoid fungal rhinosinusitis with optic nerve compression is presented, illustrating the diagnostic challenges and therapeutic considerations. Successful treatment was achieved with endoscopic transnasal sphenoidotomy, followed by close postoperative surveillance. This case highlights the importance of early recognition, accurate diagnosis, and individualized management to prevent irreversible complications and ensure favorable outcomes.

Published in	International Journal of Otorhinolaryngology (Volume 12, Issue 1)
DOI	10.11648/j.ijo.20261201.11
Page(s)	1-7
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Paranasal Sinuses, Fungal Sinusitis, Fungal Involvement of the Paranasal Cavities, Endoscopic Surgery, Transnasal Sphenoidotomy

References

[1]	A model for classification of invasive fungal rhinosinusitis by computed tomography \| Scientific Reports https://doi.org/10.1038/s41598-020-69446-5
[2]	Diagnostic and therapeutic strategies of acute invasive fungal rhinosinusitis.” Asian Journal of Surgery, 2023. https://doi.org/10.1016/j.asjsur.2022.05.006
[3]	Fungal diseases of the paranasal sinuses, 2000. (classic review) PubMed https://doi.org/10.1016/s0887-2171(99)90023-9
[4]	Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies.” Laryngoscope, 2009. https://doi.org/10.1002/lary.20520
[5]	Fungal Rhinosinusitis: An integrated diagnostic approach - PubMed https://doi.org/10.1016/j.anndiagpath.2024.152415
[6]	Fungal Rhinosinusitis: A Radiological Review With Intraoperative Correlation https://doi.org/10.1016/j.carj.2016.12.009
[7]	Imaging approach for fungal sinusitis.” Radiology / imaging review, 2024. https://doi.org/10.1097/MOO.0000000000001018
[8]	Invasive and Non-Invasive Fungal Rhinosinusitis — A Review and Update of the Evidence. MDPI Medicina, 2019 https://doi.org/10.3390/medicina55070319
[9]	Isavuconazole in the Treatment of Acute Invasive Fungal Sinusitis: Two Case Reports and Literature Review.” Frontiers in Medicine, 2025. https://doi.org/10.3389/fmed.2025.1700685
[10]	Recent Chinese review: “Research Progress of Non-Invasive Fungal Sinusitis.” 2023.
[11]	Sinonasal Fungal Infections and Complications: A Pictorial Review. Journal of Clinical Imaging Science, 2016. PubMed. https://doi.org/10.4103/2156-7514.184010
[12]	StatPearls. “Fungal Sinusitis.” Hossein Akhondi, Bersabel Woldemariam, Venkat Rajasurya. 2023.

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APA Style

Koshtoyan, A., Azizyan, V., Petrosyan, L., Ghukasyan, Y., Kirakosyan, A. (2026). Fungal Diseases of the Paranasal Sinuses. International Journal of Otorhinolaryngology, 12(1), 1-7. https://doi.org/10.11648/j.ijo.20261201.11

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ACS Style

Koshtoyan, A.; Azizyan, V.; Petrosyan, L.; Ghukasyan, Y.; Kirakosyan, A. Fungal Diseases of the Paranasal Sinuses. Int. J. Otorhinolaryngol. 2026, 12(1), 1-7. doi: 10.11648/j.ijo.20261201.11

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AMA Style

Koshtoyan A, Azizyan V, Petrosyan L, Ghukasyan Y, Kirakosyan A. Fungal Diseases of the Paranasal Sinuses. Int J Otorhinolaryngol. 2026;12(1):1-7. doi: 10.11648/j.ijo.20261201.11

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@article{10.11648/j.ijo.20261201.11,
  author = {Arsen Koshtoyan and Vilen Azizyan and Lyusi Petrosyan and Yuri Ghukasyan and Avetis Kirakosyan},
  title = {Fungal Diseases of the Paranasal Sinuses},
  journal = {International Journal of Otorhinolaryngology},
  volume = {12},
  number = {1},
  pages = {1-7},
  doi = {10.11648/j.ijo.20261201.11},
  url = {https://doi.org/10.11648/j.ijo.20261201.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijo.20261201.11},
  abstract = {Fungal rhinosinusitis comprises a heterogeneous group of diseases affecting the nasal cavity and paranasal sinuses, ranging from non-invasive colonization to rapidly progressive, life-threatening invasive infections. The clinical course and prognosis largely depend on the host immune status and the presence of tissue invasion, with invasive forms posing a high risk of orbital and intracranial complications. In recent years, the incidence of fungal rhinosinusitis has increased, likely due to improved diagnostic modalities, wider use of endoscopy, and a growing population of immunocompromised patients, including those with diabetes mellitus and post-COVID-19 conditions. This article provides a comprehensive review of fungal rhinosinusitis, focusing on current classification, epidemiology, pathophysiology, clinical manifestations, diagnostic strategies, and management principles. According to histopathological criteria, fungal rhinosinusitis is classified into non-invasive forms (saprophytic colonization, fungal ball, and allergic fungal rhinosinusitis) and invasive forms (acute invasive, chronic invasive, and granulomatous invasive fungal rhinosinusitis). Non-invasive disease typically affects immunocompetent individuals and is characterized by localized fungal accumulation or hypersensitivity reactions without tissue invasion, whereas invasive forms predominantly occur in immunocompromised patients and are associated with angioinvasion, tissue necrosis, and bone destruction. Diagnosis relies on a combination of clinical evaluation, endoscopic findings, radiologic imaging, and definitive histopathological confirmation. Computed tomography plays a key role in identifying hyperdense fungal material and bony changes, while magnetic resonance imaging is essential for assessing soft-tissue involvement and extrasinus extension. Management strategies vary according to disease type and include surgical intervention, systemic antifungal therapy, and correction of underlying predisposing factors. A clinical case of isolated sphenoid fungal rhinosinusitis with optic nerve compression is presented, illustrating the diagnostic challenges and therapeutic considerations. Successful treatment was achieved with endoscopic transnasal sphenoidotomy, followed by close postoperative surveillance. This case highlights the importance of early recognition, accurate diagnosis, and individualized management to prevent irreversible complications and ensure favorable outcomes.},
 year = {2026}
}

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TY  - JOUR
T1  - Fungal Diseases of the Paranasal Sinuses
AU  - Arsen Koshtoyan
AU  - Vilen Azizyan
AU  - Lyusi Petrosyan
AU  - Yuri Ghukasyan
AU  - Avetis Kirakosyan
Y1  - 2026/02/11
PY  - 2026
N1  - https://doi.org/10.11648/j.ijo.20261201.11
DO  - 10.11648/j.ijo.20261201.11
T2  - International Journal of Otorhinolaryngology
JF  - International Journal of Otorhinolaryngology
JO  - International Journal of Otorhinolaryngology
SP  - 1
EP  - 7
PB  - Science Publishing Group
SN  - 2472-2413
UR  - https://doi.org/10.11648/j.ijo.20261201.11
AB  - Fungal rhinosinusitis comprises a heterogeneous group of diseases affecting the nasal cavity and paranasal sinuses, ranging from non-invasive colonization to rapidly progressive, life-threatening invasive infections. The clinical course and prognosis largely depend on the host immune status and the presence of tissue invasion, with invasive forms posing a high risk of orbital and intracranial complications. In recent years, the incidence of fungal rhinosinusitis has increased, likely due to improved diagnostic modalities, wider use of endoscopy, and a growing population of immunocompromised patients, including those with diabetes mellitus and post-COVID-19 conditions. This article provides a comprehensive review of fungal rhinosinusitis, focusing on current classification, epidemiology, pathophysiology, clinical manifestations, diagnostic strategies, and management principles. According to histopathological criteria, fungal rhinosinusitis is classified into non-invasive forms (saprophytic colonization, fungal ball, and allergic fungal rhinosinusitis) and invasive forms (acute invasive, chronic invasive, and granulomatous invasive fungal rhinosinusitis). Non-invasive disease typically affects immunocompetent individuals and is characterized by localized fungal accumulation or hypersensitivity reactions without tissue invasion, whereas invasive forms predominantly occur in immunocompromised patients and are associated with angioinvasion, tissue necrosis, and bone destruction. Diagnosis relies on a combination of clinical evaluation, endoscopic findings, radiologic imaging, and definitive histopathological confirmation. Computed tomography plays a key role in identifying hyperdense fungal material and bony changes, while magnetic resonance imaging is essential for assessing soft-tissue involvement and extrasinus extension. Management strategies vary according to disease type and include surgical intervention, systemic antifungal therapy, and correction of underlying predisposing factors. A clinical case of isolated sphenoid fungal rhinosinusitis with optic nerve compression is presented, illustrating the diagnostic challenges and therapeutic considerations. Successful treatment was achieved with endoscopic transnasal sphenoidotomy, followed by close postoperative surveillance. This case highlights the importance of early recognition, accurate diagnosis, and individualized management to prevent irreversible complications and ensure favorable outcomes.
VL  - 12
IS  - 1
ER  -

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Author Information

Arsen Koshtoyan

Department of Otorhinolaryngology, Astghik Medical Center, Yerevan, Armenia
Vilen Azizyan

Department of Neurosurgery, Astghik Medical Center, Yerevan, Armenia
Lyusi Petrosyan

Department of Otorhinolaryngology, Astghik Medical Center, Yerevan, Armenia

Contact Email
Yuri Ghukasyan

Department of Otorhinolaryngology, Astghik Medical Center, Yerevan, Armenia
Avetis Kirakosyan

Department of Neurosurgery, Astghik Medical Center, Yerevan, Armenia

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Plain Text BibTeX RIS

APA Style

Koshtoyan, A., Azizyan, V., Petrosyan, L., Ghukasyan, Y., Kirakosyan, A. (2026). Fungal Diseases of the Paranasal Sinuses. International Journal of Otorhinolaryngology, 12(1), 1-7. https://doi.org/10.11648/j.ijo.20261201.11

Copy | Download

ACS Style

Koshtoyan, A.; Azizyan, V.; Petrosyan, L.; Ghukasyan, Y.; Kirakosyan, A. Fungal Diseases of the Paranasal Sinuses. Int. J. Otorhinolaryngol. 2026, 12(1), 1-7. doi: 10.11648/j.ijo.20261201.11

Copy | Download

AMA Style

Koshtoyan A, Azizyan V, Petrosyan L, Ghukasyan Y, Kirakosyan A. Fungal Diseases of the Paranasal Sinuses. Int J Otorhinolaryngol. 2026;12(1):1-7. doi: 10.11648/j.ijo.20261201.11

Copy | Download

@article{10.11648/j.ijo.20261201.11,
  author = {Arsen Koshtoyan and Vilen Azizyan and Lyusi Petrosyan and Yuri Ghukasyan and Avetis Kirakosyan},
  title = {Fungal Diseases of the Paranasal Sinuses},
  journal = {International Journal of Otorhinolaryngology},
  volume = {12},
  number = {1},
  pages = {1-7},
  doi = {10.11648/j.ijo.20261201.11},
  url = {https://doi.org/10.11648/j.ijo.20261201.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijo.20261201.11},
  abstract = {Fungal rhinosinusitis comprises a heterogeneous group of diseases affecting the nasal cavity and paranasal sinuses, ranging from non-invasive colonization to rapidly progressive, life-threatening invasive infections. The clinical course and prognosis largely depend on the host immune status and the presence of tissue invasion, with invasive forms posing a high risk of orbital and intracranial complications. In recent years, the incidence of fungal rhinosinusitis has increased, likely due to improved diagnostic modalities, wider use of endoscopy, and a growing population of immunocompromised patients, including those with diabetes mellitus and post-COVID-19 conditions. This article provides a comprehensive review of fungal rhinosinusitis, focusing on current classification, epidemiology, pathophysiology, clinical manifestations, diagnostic strategies, and management principles. According to histopathological criteria, fungal rhinosinusitis is classified into non-invasive forms (saprophytic colonization, fungal ball, and allergic fungal rhinosinusitis) and invasive forms (acute invasive, chronic invasive, and granulomatous invasive fungal rhinosinusitis). Non-invasive disease typically affects immunocompetent individuals and is characterized by localized fungal accumulation or hypersensitivity reactions without tissue invasion, whereas invasive forms predominantly occur in immunocompromised patients and are associated with angioinvasion, tissue necrosis, and bone destruction. Diagnosis relies on a combination of clinical evaluation, endoscopic findings, radiologic imaging, and definitive histopathological confirmation. Computed tomography plays a key role in identifying hyperdense fungal material and bony changes, while magnetic resonance imaging is essential for assessing soft-tissue involvement and extrasinus extension. Management strategies vary according to disease type and include surgical intervention, systemic antifungal therapy, and correction of underlying predisposing factors. A clinical case of isolated sphenoid fungal rhinosinusitis with optic nerve compression is presented, illustrating the diagnostic challenges and therapeutic considerations. Successful treatment was achieved with endoscopic transnasal sphenoidotomy, followed by close postoperative surveillance. This case highlights the importance of early recognition, accurate diagnosis, and individualized management to prevent irreversible complications and ensure favorable outcomes.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - Fungal Diseases of the Paranasal Sinuses
AU  - Arsen Koshtoyan
AU  - Vilen Azizyan
AU  - Lyusi Petrosyan
AU  - Yuri Ghukasyan
AU  - Avetis Kirakosyan
Y1  - 2026/02/11
PY  - 2026
N1  - https://doi.org/10.11648/j.ijo.20261201.11
DO  - 10.11648/j.ijo.20261201.11
T2  - International Journal of Otorhinolaryngology
JF  - International Journal of Otorhinolaryngology
JO  - International Journal of Otorhinolaryngology
SP  - 1
EP  - 7
PB  - Science Publishing Group
SN  - 2472-2413
UR  - https://doi.org/10.11648/j.ijo.20261201.11
AB  - Fungal rhinosinusitis comprises a heterogeneous group of diseases affecting the nasal cavity and paranasal sinuses, ranging from non-invasive colonization to rapidly progressive, life-threatening invasive infections. The clinical course and prognosis largely depend on the host immune status and the presence of tissue invasion, with invasive forms posing a high risk of orbital and intracranial complications. In recent years, the incidence of fungal rhinosinusitis has increased, likely due to improved diagnostic modalities, wider use of endoscopy, and a growing population of immunocompromised patients, including those with diabetes mellitus and post-COVID-19 conditions. This article provides a comprehensive review of fungal rhinosinusitis, focusing on current classification, epidemiology, pathophysiology, clinical manifestations, diagnostic strategies, and management principles. According to histopathological criteria, fungal rhinosinusitis is classified into non-invasive forms (saprophytic colonization, fungal ball, and allergic fungal rhinosinusitis) and invasive forms (acute invasive, chronic invasive, and granulomatous invasive fungal rhinosinusitis). Non-invasive disease typically affects immunocompetent individuals and is characterized by localized fungal accumulation or hypersensitivity reactions without tissue invasion, whereas invasive forms predominantly occur in immunocompromised patients and are associated with angioinvasion, tissue necrosis, and bone destruction. Diagnosis relies on a combination of clinical evaluation, endoscopic findings, radiologic imaging, and definitive histopathological confirmation. Computed tomography plays a key role in identifying hyperdense fungal material and bony changes, while magnetic resonance imaging is essential for assessing soft-tissue involvement and extrasinus extension. Management strategies vary according to disease type and include surgical intervention, systemic antifungal therapy, and correction of underlying predisposing factors. A clinical case of isolated sphenoid fungal rhinosinusitis with optic nerve compression is presented, illustrating the diagnostic challenges and therapeutic considerations. Successful treatment was achieved with endoscopic transnasal sphenoidotomy, followed by close postoperative surveillance. This case highlights the importance of early recognition, accurate diagnosis, and individualized management to prevent irreversible complications and ensure favorable outcomes.
VL  - 12
IS  - 1
ER  -

Copy | Download