There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.

Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

I and i

Background
Sinonasal fungus ball (FB) is a type of noninvasive fungal rhinosinusitis affecting immunocompetent hosts. FB, previously considered rare, has been reported with increasing frequency. We reviewed our experience of 538 cases over the past 20 years.

Methods
We retrospectively examined clinical records including clinical presentations, radiological findings, management, and outcomes of FB patients who have undergone surgery for treatment. The number of FB patients who underwent endoscopic sinus surgery (ESS) was calculated annually. Causal relationships between structural variations and FB were also investigated.

Results
The number of FB patients who underwent sinus surgery has increased. The mean age was 58.3 years, and the gender ratio was approximately 2 (female): 1 (male). While the most common presenting symptoms of maxillary sinus FB patients were nasal symptoms, such as postnasal drip and nasal obstruction, sphenoid sinus FB patients presented with headache mostly. On computed tomography (CT) scans, the most common finding was intralesional hyperdensity (77.3%). There was no significant correlation between the presence of FB and structural variations (nasal septal deviation, concha bullosa, Haller cell). Median follow-up period of the patients was 11 months. Recurrence or residual disease occurred in only 6 (1.1%) cases.

Conclusion
The number of FB patients who underwent surgery has increased steadily over the past 20 years. FB should be considered in patients with unilateral nasal symptoms and unexplained headaches. A preoperative CT scan is an essential tool in making diagnosis easier and faster. Endoscopic surgery is the treatment of choice, with a low morbidity and recurrence rate.

A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015).

Introduction and objectives The fungus ball is the most frequent type of fungal rhino-sinusitis. The objective of this study is to analyse the clinical and surgical features of our patients. Methods Retrospective analysis of 35 patients with fungus ball treated in our centre between 2006 and 2014. Results Mean age was 55 years old. 49% were men and 51% women. 75% involved the maxillary sinus, whereas 25% involved the sphenoid. 69% of our patients showed microcalcifications in the CT study. All the patients were surgically treated, with no cases of recurrence. Conclusions Clinical manifestations of fungus ball are non-specific, therefore endoscopy and image study are mandatory. The definitive diagnosis is made by histopathological study of the lesion. Endoscopic sinus surgery is the treatment of choice, with opening of the diseased sinus and complete removal of the fungus ball. The frequency of complications is very low. No oral or topical antimycotic treatments are necessary.

Fungus ball of the paranasal sinuses: Analysis of our serie of patients.

Fungus is one of the causes of chronic rhinosinusitis. If the fungus occupies the sinus but does not invade the sinonasal mucosa, this is called sinus fungus ball. Any association between anatomical variations and fungus ball remains unclear. Sinus fungus ball is defined as non-invasive chronic fungal rhinosinusitis occurring in immunocompetent patients, and the maxillary sinus is the most commonly affected. The etiology of maxillary sinus fungus ball remains unclear. This study assessed the potential contribution of anatomical variations, such as deviated nasal septum, concha bullosa, and Haller cell to the development of fungus ball in the maxillary sinus. Concha bullosa and Haller cell are structural variations that narrow the nasal airflow passage and contribute to chronic rhinosinusitis. The involvement of these variations has been investigated in chronic sinusitis but not in sinus fungus ball. Preoperative computed tomography findings of 103 patients with maxillary sinus fungus ball were evaluated retrospectively. Septal deviation and Haller cell were not correlated with the side of maxillary sinus fungus ball. Concha bullosa was more common on the unaffected side (p = 0.099). When we analyzed males and females separately, maxillary sinus fungus ball was more common on the concave side of the deviated septum in only male patients (p = 0.006). The high incidence of maxillary fungus ball in the concave side may reflect the consequences of the traumatic effects caused by wall shear stress of the high-velocity airflow and the increased chance of inhaling fungus spores.

http://www.journal.med.tohoku.ac.jp/2323/232_201.pdf

Septal deviation is associated with maxillary sinus fungus ball in male patients.

Resumen Introduccion y objetivos La bola fungica es la forma mas frecuente de rinosinusitis fungica. El objetivo de nuestro estudio es analizar las caracteristicas clinicas y los resultados de la cirugia en nuestra serie de pacientes. Metodos Se analizaron retrospectivamente 35 pacientes con bola fungica tratados en nuestro centro entre 2006 y 2014. Resultados La edad media fue de 55 anos. El 49% de los pacientes fueron varones y el 51% mujeres. El 75% se localizaron en el seno maxilar y el 25% restante en el seno esfenoidal. La clinica mas frecuente fue obstruccion nasal, rinorrea y algias craneofaciales. El 69% de pacientes mostro microcalcificaciones intrasinusales en la tomografia computerizada. Todos los pacientes fueron intervenidos quirurgicamente, sin registrarse recidivas. Conclusiones Las manifestaciones clinicas de la bola fungica son muy inespecificas, por lo que el diagnostico de sospecha se hace mediante endoscopia y estudio de imagen. El estudio histopatologico confirma el diagnostico. La cirugia endoscopica nasosinusal es la base del tratamiento de la bola fungica, limitandose a la apertura del seno (o senos) afecto, y exeresis completa de la lesion. La tasa de complicaciones postoperatorias es muy baja, y no es necesario tratamiento antifungico oral o topico concomitante.

Bola fúngica sinusal: análisis de nuestra casuística

This study aims to determine the relationship between nasal septal deviation, concha bullosa, and chronic rhinosinusitis by using a definitive pathological and simplified model Fifty-two consecutive sinus computed tomography scans were performed on patients who received endoscopic sinus surgery and whose final diagnosis was paranasal sinus fungus balls The incidences of nasal septal deviation and concha bullosa for patients diagnosed with paranasal sinus fungus balls among the study group were 423% and 25%, respectively About 636% sinuses with fungus balls were located on the ipsilateral side of the nasal septal deviation, and 462% were located on the ipsilateral side of the concha bullosa When examined by Pearson's chi-square test and the chi-squared goodness-of-fit test, no significant statistical difference for the presence of paranasal sinus fungus balls between ipsilateral and contralateral sides of nasal septal deviation and concha bullosa was noted (P = 0292 and P = 0593, resp) In conclusion, we could not demonstrate any statistically significant correlation between the location of infected paranasal sinus, the direction of nasal septal deviation, and the location of concha bullosa, in location-limited rhinosinusitis lesions such as paranasal sinus fungal balls We conclude that the anatomical variants discussed herein do not predispose patients to rhinosinusitis

/pdf/there-is-no-structural-relationship-between-nasal-septal-2e9ess5gua.pdf

There is no structural relationship between nasal septal deviation, concha bullosa, and paranasal sinus fungus balls

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There is no structural relationship between nasal septal deviation, concha bullosa, and paranasal sinus fungus balls