Abstract
Objectives: Maxillary sinus fungal balls (MSFBs) mostly occur
in older individuals and demonstrate female predominance. Early
diagnosis is important to avoid treatment delays. This study aimed to
elucidate the differences in clinical and imaging presentation of MSFB
with and without intralesional hyperdensity (IH).
Design and setting: This was a retrospective review in a
tertiary medical center. We retrospectively identified 588 patients
underwent endoscopic sinus surgery procedures for MSFB between 2005 and
2018. The clinical characteristics and computed tomography (CT) findings
including the presence of complete or partial opacification, IH, and
odontogenic pathology were reviewed.
Participants: 588 MSFB patients
Results: Patients with unilateral MSFB had a mean age of 57.4
years and demonstrated female predominance (64.63%). The overall
female-to-male ratio was highest at 51-60 years (2.02) and rose to 2.60
in MSFB with IH only. Compared to those with IH, MSFB without IH was
significantly more common in males (OR = 2.496; P < .0001), in
those with diabetes mellitus (DM) (OR = 2.094; P = .010) and adjacent
maxillary odontogenic pathology (OR = 1.697; P = .030). Complete
opacification on CT was less common in MSFB without IH (OR = 0.617; P =
.025).
Conclusion: The highest female-to-male ratio for MSFB at 51-60
years corresponded to the age of menopause. Patients with MSFB without
IH were more likely to have DM, no female predominance, adjacent
maxillary odontogenic pathology, and partial opacification of the sinus,
compared to those with IH. These clinical features may aid earlier
identification of MSFB without IH.