A clinical comparative study of an outpatient treatment group and an endoscopic sinus surgery group for maxillary sinus fungus ball

This study aimed to clarify the differences in the pathophysiology of maxillary sinus fungus balls (FB) among different case groups and to identify which patients with maxillary sinus FB would be suitable for outpatient procedures.

Thirty-four patients diagnosed with maxillary sinus FB between January 2017 and December 2021 were divided into two groups (O and S). We retrospectively compared the clinical and imaging characteristics, and the treatment outcomes between the groups. Group O comprised 12 patients (13 sides) treated in an outpatient clinic and Group S comprised 15 patients (16 sides) treated with endoscopic sinus surgery (ESS).

Compared to Group S, Group O had more patients with an enlarged maxillary sinus membranous portion, and shadows indicative of fungal masses (P < 0.01 and P < 0.05, respectively). In particular, the anteroposterior ratio of the open maxillary sinus membranous area was 0.68 ± 0.16 in Group O and 0.5 ± 0.12 in Group S. After surgery, Group O exhibited greater anteroposterior expansion of the maxillary sinus membranous portion compared to Group S (P < 0.01). Additionally, Group O had more patients with shadows in sinuses other than the maxillary sinus (P < 0.01) and medial displacement of the uncinate process (P < 0.01) than Group S. In addition, Group O required fewer procedures and hospital visits than Group S (P < 0.001 and P < 0.01, respectively).

Determining the indications for outpatient procedures while considering the pathophysiology of maxillary sinus FB can significantly benefit patients and medical professionals in terms of safety and medical costs.