Topical antifungal agents such as nystatin, tolnaftate, dilute acetic acid, and topical corticosteroids are therapeutic. Oral itraconazole has also been effective, but experience with it is limited. Aspergillus noninvasive sinonasal disease may present in three forms. 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.