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Black Fungus – Is this new?

Every human being is born with sinuses. There are 4 types of sinuses viz Maxillary Sinus, Ethmoid Sinus, Frontal Sinus and Sphenoid Sinus. Maxillary sinuses are one in either cheek. Ethmoid sinuses are between eyes on each side of nose. Frontal sinuses are in the forehead area and sphenoid sinuses are behind the ethmoid sinuses i.e behind eyes. When there is infection or inflammation in any of these sinuses then this is called sinusitis.

Why Sinusitis Happens?

To understand the reason for infection, first we need to understand how the aeration in the sinus happens. The air we breathe through our nose goes into the sinuses where it gets humidified. This humidified air goes into the throat from where it goes into the ears through the Eustachian tubes behind the tonsils. So precisely the air we breathe travels from nose to throat and then to an ear which is why ENT (Ear Nose and Throat) is put under one specialty.

However, this circulation of air in many people is not normal as explained above. This can be due to many reasons:

  • A Deviated Nasal Septum (DNS) – A Deviated Nasal Septum is a condition where the bone that divides the two nostrils is deviated towards one side. This can cause mild to severe obstruction in airway leading to lack of aeration in sinuses.
  • Nasal Polyps – Nasal Polyp is a tissue growth which originates from the sinuses and blocks the airways. Polyps are notorious and tend to come back if not taken care of after removal.
  • Hypertrophied Turbinated – Turbinates are long narrow passage in the nose when they swell up or are too large they can lead to blockage in the airway.

What are the types of Sinusitis?

Mainly there are two types of infective sinusitis which can be termed as bacterial sinusitis and fungal sinusitis. There is lot of hue and cry about black fungus which is actually a type of fungal sinusitis and it is nothing new it existed before the Covid era as well. Symptoms of bacterial and fungal sinusitis are almost same. “I have been getting lot of patients who have taken course of steroid during covid and are scared that it might be invasive fungal sinusitis. Let me be very clear that all fungal sinusitis are not invasive. Also to differentiate fungal and bacterial sinusitis you mostly do not need a MRI of PNS. Infact a simple CT scan of para nasal sinuses is also good enough. In the CT images we can differentiate between a fungal and bacterial sinusitis. The best part is that the treatment for both kind of sinusitis is same. In both the cases we need to operate upon the patient through FESS (Functional Endoscopic Sinus Surgery). Yes, there is definitely risk in case of fungal sinusitis as it can start eating into the bone and can invade to optic nerve as well as brain. Hence incase of invasive fungal sinusitis anti fungal needs to be started along with the debridement surgery at the earliest”, says Dr Priyanjana Acharyya Sharma, leading ENT specialist and surgeon in Gurgaon.

Dr Priyanjana Acharyya Sharma, MBBS, MS (ENT) Gold Medalist

Why is oxygen therapy during covid leading to fungal sinusitis?

Fungus thrives on moisture that is why earlier cases of black fungus that emerged in India were mainly in the coastal areas and in the areas close to water bodies. However, when a patient is on oxygen therapy, oxygen is supplied through humidifier. Hence when the patient is on long term oxygen support there is lot of humidification that he gets through the nose which helps the fungus to grow. Invasive fungul sinusitis is mostly seen in patients who are immuno-compromised or having co-morbidities like diabetes.

Like every other disease if fungal sinusitis is diagnosed and treated in time then the risk of invasion can be reduced to minimum.

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