Amphotericin B with its attendant toxicity is not indicated, and newer, less toxic antifungal agents have not been shown to be useful. Daily sinus irrigation with warm isotonic saline can prevent impaction of mucus. Postoperatively oral prednisone in a dose of 10 to 20 mg per day is given for a minimum of two weeks, followed by the same dose on alternate days for an additional two weeks or longer. Full dose, short acting intranasal corticosteroids are prescribed on a long term basis. Postoperatively patients benefit from regular nasal endoscopy to remove any synechiae or polyps that may develop.
Treatment is again with steroids with clearance of the affected sinus.
Sinus Mycetoma Patients with sinus mycetomas or fungus balls usually seek medical attention because of nasal obstruction, chronic sinusitis, facial pain, or foul smell. Mycetomas principally involve the maxillary sinus and may be associated with nasal polyps and bacterial sinusitis. Fungi may not grow from the hyphae rich material obtained at surgery since fungal elements in mycetomas have a low viability. Aspergillus fumigatus is the most common cause of mycetomas. Diagnosis of sinus mycetoma consists of five features.