The different clinical manifestations and diagnostic strategies of isolated sphenoid non-invasive fungal sinusitis

Objective: To present the different clinical manifestations and diagnostic strategies of isolated sphenoid non-invasive fungal sinusitis (SNIFS) in order to prevent delayed diagnosis and providing early management. Method: This study is a retrospective clinical study, conducted between January 2008 to November 2019. It was done in the ENT department of two institutes: King Fahad specialist Hospital and Qatif Central Hospital, Saudi Arabia. Only patients with sole involvement of non-invasive fungal sinusitis in the sphenoid sinus were included. Result: A diagnosis of isolated sphenoid fungal ball and allergic fungal rhinosinusitis had been made in 14 patients with the age ranging between 14-50 years old. 8 were males and the 6 remaining were females. The most common symptoms were headache and nasal discharge. Even though CT scan was the most important tool in the diagnosis, the conformation of the diagnosis was made either intraoperatively or by fungal culture. Conclusion: The incidence of SNIFS is rare. However, it’s clinically important because untreated SNIFS can cause significant complications. The clinical features of SNIFS are ambiguous and nonspecific which make its diagnosis more difficult. Post-nasal discharge and headache refractory to the medical management is the most common symptom of SNIFS. CT scan is still the cornerstone of radiological diagnosis of SNIFS. Endoscopic sinus surgery is the standard care of management.