No allergic mucin is present in sinus mycetoma. However, the sinus contains dense material that consists of hyphae separate from, but adjacent to the mucosa. There is no invasion of the sinus mucosa. Necrosis of the mucosa, submucosa, and blood vessels, with low-grade inflammation, is seen in chronic invasive fungal sinusitis. Granuloma with multinucleated giant cells with pressure necrosis and erosion is seen in granulomatous invasive fungal sinusitis.
Medical treatment depends on the type of infection and the presence of invasion.
Allergic fungal sinusitis Treatment of choice generally is surgery. Systemic steroids may be indicated once surgery is performed and the diagnosis is confirmed. Topical nasal steroids are very helpful postoperatively. Aggressive nasal salt-water washes are recommended. Immune therapy for specific allergens is controversial, even though some reports suggest benefit from this treatment.