{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T02:26:30Z","timestamp":1781922390656,"version":"3.54.5"},"reference-count":26,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T00:00:00Z","timestamp":1696809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Taiwan National Science and Technology Council","award":["111-2314-B-182-067-"],"award-info":[{"award-number":["111-2314-B-182-067-"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Maxillary sinus fungal ball (MSFB) is the most common type of non-invasive fungal rhinosinusitis. Since MSFB requires a unique treatment strategy and is associated with potentially severe complications, timely and precise diagnosis is crucial. Computed tomography (CT) is the first-line imaging tool for evaluating chronic rhinosinusitis. Accordingly, we aimed to investigate the clinical and CT imaging characteristics of MSFB. We retrospectively enrolled 97 patients with unilateral MSFB and 158 with unilateral non-fungal maxillary rhinosinusitis. The clinical characteristics, laboratory data, and CT imaging features of participants were evaluated. Older age, female sex, lower white blood cell and neutrophil counts, and CT imaging features (including an irregular surface, erosion of the medial sinus wall, sclerosis of the lateral sinus wall, and intralesional hyperdensity) were significantly associated with MSFB. The presence of adjacent maxillary odontogenic pathology was associated with a decreased likelihood of the incidence of MSFB in unilateral maxillary rhinosinusitis. Separate nomograms were created for patients, without and with the use of CT scan, to predict the probabilities of MSFB in patients with unilateral maxillary rhinosinusitis. We proposed two nomograms based on the clinical and CT characteristics of patients with MSFB. These could serve as evaluation tools to assist clinicians in determining the need for undergoing CT and facilitate the accurate and timely diagnosis of MSFB.<\/jats:p>","DOI":"10.3390\/diagnostics13193156","type":"journal-article","created":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T10:48:33Z","timestamp":1696848513000},"page":"3156","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Predicting the Probability of the Incidence of Maxillary Sinus Fungus Ball in Patients Using Nomogram Models"],"prefix":"10.3390","volume":"13","author":[{"given":"Yu-Hsi","family":"Fan","sequence":"first","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Yi","family":"Shih","sequence":"additional","affiliation":[{"name":"School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Wen","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9647-1135","authenticated-orcid":false,"given":"Yen-Lin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"School of Medicine, National Tsing-Hua University, Hsinchu 300, Taiwan"},{"name":"Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0508-1359","authenticated-orcid":false,"given":"Ta-Jen","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen 361028, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Che","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Hung","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4188-3498","authenticated-orcid":false,"given":"Chien-Chia","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1002\/lary.20520","article-title":"Fungal rhinosinusitis: A categorization and definitional schema addressing current controversies","volume":"119","author":"Chakrabarti","year":"2009","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S0091-6749(97)70073-3","article-title":"Criteria for the diagnosis of sinus mycetoma","volume":"99","author":"deShazo","year":"1997","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1111\/coa.13109","article-title":"Acute invasive fungal rhinosinusitis in twenty-one diabetic patients","volume":"43","author":"Wu","year":"2018","journal-title":"Clin. Otolaryngol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Roland, L.T., Humphreys, I.M., Le, C.H., Babik, J.M., Bailey, C.E., Ediriwickrema, L.S., Fung, M., Lieberman, J.A., Magliocca, K.R., and Nam, H.H. (Int. Forum Allergy Rhinol., 2023). Diagnosis, Prognosticators, and Management of Acute Invasive Fungal Rhinosinusitis: Multidisciplinary Consensus Statement and Evidence-Based Review with Recommendations, Int. Forum Allergy Rhinol., epub ahead of print.","DOI":"10.1002\/alr.23132"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1002\/lary.27869","article-title":"A retrospective analysis of 1717 paranasal sinus fungus ball cases from 2008 to 2017","volume":"130","author":"Liu","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.wjorl.2017.01.003","article-title":"Evidence for a \u2018preinvasive\u2019 variant of fungal sinusitis: Tissue invasion without angioinvasion","volume":"3","author":"Paknezhad","year":"2017","journal-title":"World J. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1002\/alr.22007","article-title":"A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996\u20132015)","volume":"7","author":"Yoon","year":"2017","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"23945","DOI":"10.1038\/s41598-021-03507-1","article-title":"Differences in clinical and imaging presentation of maxillary sinus fungus ball with and without intralesional hyperdensity","volume":"11","author":"Wu","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"227","DOI":"10.2500\/105065800779954446","article-title":"Diagnostic accuracy in sinus fungus balls: CT scan and operative findings","volume":"14","author":"Dhong","year":"2000","journal-title":"Am. J. Rhinol."},{"key":"ref_10","first-page":"377","article-title":"Analysis of predisposing factors in unilateral maxillary sinus fungal ball: The predictive role of odontogenic and anatomical factors","volume":"60","author":"Doo","year":"2022","journal-title":"Rhinology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1002\/lary.27670","article-title":"Diagnosis of a maxillary sinus fungus ball without intralesional hyperdensity on computed tomography","volume":"129","author":"Ho","year":"2019","journal-title":"Laryngoscope"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2500\/ajra.2012.26.3707","article-title":"The significance of computed tomographic findings in the diagnosis of fungus ball in the paranasal sinuses","volume":"26","author":"Chen","year":"2012","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_13","first-page":"153","article-title":"Identifying a sphenoid sinus fungus ball using a nomogram model","volume":"61","author":"Fan","year":"2023","journal-title":"Rhinology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2793","DOI":"10.1007\/s00405-020-06164-8","article-title":"The effect of surgical menopause after bilateral oophorectomy on hormonal changes, mucociliary clearance, and quality of life","volume":"277","author":"Gumussoy","year":"2020","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s00405-014-3118-z","article-title":"Does menopause effect nasal mucociliary clearance time?","volume":"272","author":"Akbay","year":"2015","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1159\/000027713","article-title":"Nasal mucosal swelling and reactivity during a menstrual cycle","volume":"62","author":"Stjerna","year":"2000","journal-title":"ORL J. Otorhinolaryngol. Relat. Spec."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1111\/jdi.13183","article-title":"Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors","volume":"11","author":"Lao","year":"2020","journal-title":"J. Diabetes Investig."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1016\/j.jaci.2018.03.004","article-title":"Endotype-driven care pathways in patients with chronic rhinosinusitis","volume":"141","author":"Bachert","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4193\/Rhin20.401","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"Fokkens","year":"2020","journal-title":"Rhinology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.3109\/00016489.2012.659756","article-title":"The role of mucosal immunity in fungus ball of the paranasal sinuses","volume":"132","author":"Park","year":"2012","journal-title":"Acta Otolaryngol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1160\/TH14-01-0074","article-title":"Platelet immunology in fungal infections","volume":"112","author":"Speth","year":"2014","journal-title":"Thromb. Haemost."},{"key":"ref_22","first-page":"82","article-title":"Platelets and infections-complex interactions with bacteria","volume":"6","author":"Damien","year":"2015","journal-title":"Front. Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Jiang, Z., Zhang, K., Huang, W., and Yuan, Q. (2016). A Preliminary Study on Sinus Fungus Ball with MicroCT and X-ray Fluorescence Technique. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148515"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1002\/lio2.147","article-title":"Odontogenic sinusitis: A review of the current literature","volume":"3","author":"Little","year":"2018","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"320","DOI":"10.3109\/00016488609132845","article-title":"Chronic maxillary sinusitis. Definition, diagnosis and relation to dental infections and nasal polyposis","volume":"101","author":"Lindahl","year":"1986","journal-title":"Acta Otolaryngol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.tripleo.2006.08.014","article-title":"Risk of maxillary fungus ball in patients with endodontic treatment on maxillary teeth: A case-control study","volume":"103","author":"Mensi","year":"2007","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/19\/3156\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:03:36Z","timestamp":1760130216000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/19\/3156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,9]]},"references-count":26,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["diagnostics13193156"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13193156","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,9]]}}}