Chronic or indolent sinusitis is confined to one sinus and presents as a chronic infection that is unresponsive to antibacterial therapy. Sinus radiograms are nonspecific, showing mucosal thickening without bony changes. Endoscopic surgery is curative in most cases. Sinus aspergilloma, which is rare in children, presents with long-standing nasal symptoms. Sinus radiographs demonstrate a solitary mass in the ethmoid or maxillary sinus.
Bony destruction is variable.
Surgical removal of the mass, often endoscopically, is the treatment of choice. Allergic fungal sinusitis involves multiple sinuses and occurs in immunocompetent individuals who usually have a history of multiple preceding sinus surgeries and nasal polyposis. Aspergillus species and less often Curvularia lunata are the usual etiologic agents. Histology of nasal secretions in these patients reveals thick mucin, eosinophils, and few fungal hyphae. Sinus imaging typically shows involvement of multiple sinuses with hypodense areas, occasional calcifications, and occasional bony erosions.