How To Get Rid Of Fungus In Your Sinus
Dr Kevin Soh describes what is fungal sinusitis, and how it can cause nose polyps. Learn how surgeons approach the maxillary sinus.
3 Mount Elizabeth, #07-02, Mount Elizabeth Medical Centre, Singapore 228510
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If you prefer to read, rather than watch the video, here’s the transcript.
0:16 – A fungus is a plant-like organism lacking chlorophyll, and is therefore unable to carry out photosynthesis. It cannot make food by absorbing energy from the sun. Instead, it absorbs food and water from dead organic matter (saprophytic), and sometimes from live ones too (parasitic). Because it does not need light to survive, it can live in dark damp places, e.g. in your sinuses!
0:35 – Photo of Aspergillus fumigatus
0:43 – Fungal sinusitis may be: Non-invasive (no tissue destruction, infects immune-competent host) or Invasive (has tissue invasion, destroys adjacent tissues, may affect eye and brain, affects immuno-compromised host, and is associated with a bad prognosis).
1:08 – Types of fungal sinusitis: Non-invasive (which may be fungal ball or mycetoma, or allergic fungal sinusitis). Invasive (which may be acute fulminant type, or chronic invasive type).
1:22 – The significance of calcification in the sinuses: If calcification is seen in the maxillary sinus, it is fungal sinusitis until proven otherwise. Often, a polyp forms as a natural consequence of the inflammation induced by the fungal infection.
1:36 – The objective of surgery is to completely remove the fungus in the sinus. This can be achieved by:
a) Widening the maxillary sinus opening (by using endoscopic sinus surgery),
b) Creating an inferior meatus antrostomy,
c) Creating an opening in the front wall of the maxillary sinus (Caldwell Luc procedure).
2:42 – Surgical demonstration of “widening of maxillary sinus opening” using a microdebrider. First, we remove the nose polyp with a microdebrider. Then we start to see some fungal elements. The fungus is thick, dark, and clumpy. The fungus has a clay-like consistency. It is difficult to suck out, and also difficult to grasp with forceps. I also trim the middle turbinate to reduce the probability of post-operative ethmoid stenosis. The maxillary sinus opening is now nice and wide to allow adequate drainage and ventilation.
4:36 – Surgical demonstration of “creating an inferior meatal antrostomy”. The inferior turbinate is elevated and medialized to expose the inferior meatus. The opening is enlarged with forward and back biting forceps. A microdebrider is used to clean up loose tags of mucosa.
5:17 – Surgical demonstration of “to open the front wall of the maxillary sinus” or Caldwell Luc procedure. A burr side-cutting drill is used to enlarge the opening. By inserting a Hopkin’s telescope through the opening, fungus is seen in the maxillary sinus. The fungus is slowly teased out of its hiding place in the maxillary sinus.
6:27 – Post-operative views. This is how it looks like one month after surgery. The maxillary sinus opening is nice and wide. No more fungus or polyps can be seen.