{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:09:05Z","timestamp":1772168945748,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.67204.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000}}],"reference-count":15,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Introduction:\u00a0<\/ns4:bold>\n                    Fungal rhinosinusitis (FRS) remains a rare disease. The noninvasive forms are hard to diagnose. The management protocols remain controversial. We aim to describe the clinical, radiological and pathological features of noninvasive FRS and present our management protocol and follow-up results.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Patients and methods:\u00a0<\/ns4:bold>\n                    This descriptive study was conducted in the ear-nose-throat department of the university hospital, Taher Sfar in Mahdia, Tunisia. All patients who responded to the definition of noninvasive FRS (fungal balls and allergic fungal sinusitis) were included. The study was conducted over a three year period (May 2017 \u2013 April 2021).\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:\u00a0<\/ns4:bold>\n                    Eleven patients were included in this study: four cases of fungal balls and seven cases of allergic fungal sinusitis. Patients presented with symptoms of chronic recurrent rhinosinusitis with no response to conventional treatments. Computed tomodensitometry scan showed opacification of the paranasal sinuses in all patients. Other signs were heterogeneous opacities, local calcifications and thinning of the bony walls of the sinuses.\n                  <\/ns4:p>\n                  <ns4:p>Histopathological findings were inflammatory polyps in all cases of allergic FRS with the presence of fungal hyphae in 42.8% of the cases.<\/ns4:p>\n                  <ns4:p>All patients underwent surgery after a median delay of 12 [6\u201324] months of the symptom\u2019s onset. The used procedures were endoscopic middle meatal antrostomy for all patients, ethmoidectomy (81.8%) and sphenoidotomy (36.4%). None received systemic antifungals or corticosteroids with a favorable outcome in all cases.<\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusion:\u00a0<\/ns4:bold>\n                    Symptoms of noninvasive FRS are nonspecific. The scan images contribute to the diagnosis, but the perioperative findings and the histopathological results remain crucial. \u00a0The management is mainly surgical.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.67204.2","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T11:20:06Z","timestamp":1663154406000},"page":"869","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Noninvasive fungal rhinosinusitis: a case series"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8954-2070","authenticated-orcid":false,"given":"Mohamed","family":"Masmoudi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihene","family":"Chelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7150-9515","authenticated-orcid":false,"given":"Asma","family":"Ben Mabrouk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0751-7796","authenticated-orcid":false,"given":"Ezer","family":"Chebil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1686-989X","authenticated-orcid":false,"given":"Wadii","family":"Thabet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2058-734X","authenticated-orcid":false,"given":"Mehdi","family":"Hasnaoui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalifa","family":"Mighri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"351-8","DOI":"10.2500\/ajra.2012.26.3807","article-title":"The role of fungi in diseases of the nose and sinuses.","volume":"26","author":"Z Soler","year":"2012","journal-title":"Am J Rhinol Allergy."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"164-79","DOI":"10.1007\/s12663-018-01182-w","article-title":"Fungal Rhinosinusitis: Unravelling the Disease Spectrum.","volume":"18","author":"V Singh","year":"2019","journal-title":"J Maxillofac Oral Surg."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"43-9","DOI":"10.1097\/MOO.0b013e32831de91e","article-title":"Fungus as the cause of chronic rhinosinusitis: The case remains unproven.","volume":"17","author":"F Ebbens","year":"2009","journal-title":"Curr Opin Otolaryngol Head Neck Surg."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"677-88","DOI":"10.1016\/j.iac.2009.07.002","article-title":"Fungus: A Role in Pathophysiology of Chronic Rhinosinusitis, Disease Modifier, A Treatment Target, or No Role at All?","volume":"29","author":"W Fokkens","year":"2009","journal-title":"Immunol Allergy Clin North Am."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"1809-18","DOI":"10.1002\/lary.20520","article-title":"Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies.","volume":"119","author":"A Chakrabarti","year":"2009","journal-title":"Laryngoscope."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"672-92","DOI":"10.1016\/j.rmr.2016.09.004","article-title":"[Fungal sinusitis].","volume":"34","author":"E Lafont","year":"2017","journal-title":"Rev Mal Respir."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"103-5","DOI":"10.1016\/j.mycmed.2008.03.001","article-title":"Les sinusites aspergillaires : \u00e0 propos de trois cas dans l\u2019h\u00f4pital de Sfax, Tunisie.","volume":"18","author":"F Makni","year":"2008","journal-title":"J Mycol Med."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"e357-66","DOI":"10.1016\/S1473-3099(17)30309-2","article-title":"Pulmonary and sinus fungal diseases in non-immunocompromised patients.","volume":"17","author":"D Denning","year":"2017","journal-title":"Lancet Infect Dis."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"831-8","DOI":"10.1001\/jamaoto.2020.1453","article-title":"Contemporary Classification of Chronic Rhinosinusitis Beyond Polyps vs No Polyps: A Review.","volume":"146","author":"J Grayson","year":"2020","journal-title":"JAMA Otolaryngol Head Neck Surg."},{"key":"ref-10","article-title":"Mycoses aspergillaires des sinus maxillaires.","author":"C Delbet","year":"2013"},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"277-81","DOI":"10.1016\/j.oooo.2019.08.008","article-title":"Computed tomography-based differential diagnosis of fungus balls in the maxillary sinus.","volume":"129","author":"D Lee","year":"2020","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"474-81","DOI":"10.1016\/j.humpath.2003.10.024","article-title":"Fungal sinusitis: histologic spectrum and correlation with culture.","volume":"35","author":"L Granville","year":"2004","journal-title":"Hum Pathol."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"1-464","DOI":"10.4193\/Rhin20.600","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020.","volume":"58","author":"W Fokkens","year":"2020","journal-title":"Rhinology."},{"key":"ref-14","first-page":"870-4","article-title":"Effectiveness of itraconazole in the management of refractory allergic fungal rhinosinusitis.","volume":"37","author":"K Chan","year":"2008","journal-title":"J Otolaryngol Head Neck Surg."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"25-8","DOI":"10.1016\/j.allerg.2004.10.011","article-title":"Agent fongique et pathologie rhinosinusienne Fungal infection and rhinosinusitis.","volume":"45","author":"J Klossek","year":"2005","journal-title":"Rev Fran\u00e7aise d\u2019Allergologie d\u2019Immunologie Clin."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/10-869\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-869\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-869\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T15:25:15Z","timestamp":1718724315000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/10-869\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,14]]},"references-count":15,"URL":"https:\/\/doi.org\/10.12688\/f1000research.67204.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.67204.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.136141.r150422","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.136141.r150422","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,14]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/10-869\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.70803.r93106, Senda Turki, Service ORL, H\u00f4pital FSI,Facult\u00e9 de M\u00e9decine de Tunis, Universit\u00e9 Tunis El Manar, Tunis, 17 Sep 2021, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/10-869\/v1#referee-response-93106","order":0,"name":"referee-response-93106","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Mohamed Masmoudi<\/b>; \n<i>Posted: 12 Jul 2022<\/i>; According to the recent classification of Chronic Rhinosinusitis (CRS), the fungal ball is a secondary CRS and is most often related to an endodontic history (more than 80% of cases). For the 4 fungal balls of the series, there is no information regarding the dental history, the specialized dental examination, the dentascan. The treatment of dental causes should be combined with surgical treatment to reduce the risk of recurrence. \u201cContemporary Classification of Chronic Rhinosinusitis Beyond Polyps vs No Polyps: A Review\u201d1. Jessica W Grayson, Claire Hopkins, Eri Mori, Brent Senior, Richard J Harvey.  \n<b>Author response<\/b>: We specified that none of our patients had a history of dental infection or procedure. We added in the discussion part that they were all referred to a dentist for a specialized examination.  An inferior meatal window combined with the middle meatal antrostomy for the treatment of fungal balls would reduce the risk of leaving residual debris (EPOS2020)2  \n<b>Author response<\/b>: This was added to the discussion.&nbsp;  An MRI was requested in 4 patients: What were the clinical or radiologic criteria that motivated the request for an additional MRI? What were the radiological elements that the MRI had to specify? \u200b\u200b\u200b\u200b\u200b\u200b\u200b \n<b>Author response<\/b>: We added in the method part the limitation we had since MRI is not available in our center. So it was only indicated for patients who could afford it for further specifications.  Concerning the cases of allergic fungal rhinosinusitis: a\/ The determination of serum IgE level would be an additional element in the diagnosis. b\/ Postoperative oral corticosteroid therapy over a period of 2 to 6 months (with close monitoring of side effects) demonstrated a net benefit on faster amendment of symptoms and reducing recurrences (EPOS2020)2 \u200b\u200b\u200b\u200b\u200b\u200b\u200b \n<b>Author response<\/b>: This information&nbsp;was added, the serum IgE level was not possible, since unavailable.&nbsp;  You could have added in the references, The European Position Paper on Rhinosinusitis and Nasal Polyps 20202 (the update of similar evidence-based position papers published in 2005 and 2007 and 2012): EPOS2020. \u200b\u200b\u200b\u200b\u200b\u200b\u200b \n<b>Author response<\/b>: These references were added.  Thank you for your remarks that showed the special interest you paid to our manuscript and helped improve its quality.","URL":"https:\/\/f1000research.com\/articles\/10-869\/v2#referee-comment-8508","order":1,"name":"referee-comment-8508","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.136141.r150422, Yasser M. Elbeltagy, Department of Otorhinolaryngology, Ain Shams University, Cairo, 30 Sep 2022, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/10-869\/v2#referee-response-150422","order":2,"name":"referee-response-150422","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}