Nasal or respiratory allergy during monsoon: Types of fungal sinus, when is surgery needed

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Monsoons and allergies are wedded thick or to put it simply, monsoon allergies are very bothersome where the increased moisture and damp surfaces cause dust mites and bacteria to settle on household items like carpets, rugs and duvets, making things worse but infections due to this can be managed with medications.

However, it is when the dampness causes fungus to grow, that in turn infects the sinuses and if left unchecked, it can lead to fungal sinusitis and surgical intervention.

In an interview with HT Lifestyle, ENT surgeon Dr Vikas Agrawal, shared, “The phrase ‘pain in the neck’ might be well replaced by ‘pain in the nose.’ While basic allergies that cause sneezing, congestion, itchy nose and sore throat are common and can be treated with medication, it is the fungal allergies that wreak havoc. I had a very unique experience recently. A 75-year-old woman who had undergone successful treatment for both cancer and heart issues, came to me complaining of an acute, throbbing headache. A CT scan revealed that she had a life-threatening ‘fungal sinusitis’ and needed immediate surgery. Such cases are becoming increasingly common during the monsoons.”

He explained, “The case of the 75-year-old lady described above was a textbook case of a lethal sinus infection. For one, her age and comorbidities made her a classic immunocompromised individual. Second, she had no idea that she had fungal sinusitis, which kept growing. A simple CT scan revealed that what started as a fungus-infected sinus, had progressed and was on its way to spread to the eye and even the brain, leading to fatal consequences. The only recourse was surgery.”

According to him, fungal sinusitis itself is of two types-simple and complex. The simpler ones are non-invasive in nature and one of three types –

  1. The fungal infection makes the sinuses fill up with thick mucus and nasal polyps are formed. People with asthma or allergic rhinitis (hay fever) are more likely to develop this condition.
  2. Fungi build up in the sinuses and form a clump or ball. The fungal ball can get bigger and block the sinuses.
  3. Fungus grows on the mucus inside the nose and both need removing.

Dr Vikas Agrawal revealed that all the above require basic surgical intervention. He said, “Complex sinus infections, however, are invasive and life-threatening. The infection can potentially move into the skull and brain. These are rare but fatal. In immunocompromised individuals, the fungi destroy blood vessels within the nose and the tissue begins to die. The infection can quickly spread to the eyes and brain, leading to blindness and death. Those suffering with diabetes and who are insulin-dependent, also suffer from a condition where the nasal tissue begins to die because of the fungal infection. This may progress slower than the first condition. Sometimes, the body launches an immune response to fungi. The person’s immune system itself destroys the nasal tissue.”

He highlighted, “Thanks to improved medical technologies, today, navigation-guided endoscopic sinus surgeries are possible for all the above conditions. This is a safe and painless option and ensures that the infections/ polyps don’t recur. I say this specifically because we had an instance when a 55-year-old lady came to us with polyps in her nasal cavity. She had already been operated on for her polyps using traditional surgery and was wondering how they had recurred. She was looking for medical intervention, using steroids or antihistamines. One has side effects and the other is completely ineffective against polyps. So we had to counsel her that new medical technology allows us to identify and weed out each and every polyp completely. Taking fungal sinusitis seriously is vital to long-term health and well-being.”

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