Nasal mycosis

Nasal mycosis (nasal fungal infection, fungal rhinosinusitis) is an infection caused by opportunistic fungi, most commonly of the Aspergillus or Candida genus. This condition may occur in superficial or invasive forms, with more severe forms primarily affecting immunocompromised individuals. Nasal mycosis involves the mucous membrane of the nasal cavity and paranasal sinuses and can lead to chronic inflammation, tissue destruction, and in extreme cases, orbital or intracranial complications. In clinical practice, prompt diagnosis and implementation of appropriate treatment are essential, because an untreated infection can be progressive in nature.

Nasal fungal infection – what it is

Nasal mycosis belongs to the group of fungal infections of the upper respiratory tract and includes several distinct clinical forms, differing in their course and prognosis. The following are primarily distinguished:

non-invasive fungal sinusitis – most commonly in the form of a fungal ball (so-called fungal ball), confined to the sinus lumen,
allergic fungal sinusitis – associated with a hypersensitivity reaction to fungal antigens,
invasive fungal rhinosinusitis – acute or chronic, with tissue infiltration and potential involvement of bones and orbital structures.

Predisposing factors include:

immune disorders (e.g., diabetes, immunosuppressive treatment),
chronic sinusitis,
long-term antibiotic therapy,
disturbances of the mucosal microbiome,
the presence of foreign bodies or previous surgical procedures within the nose.

Pathogenesis is based on the colonization of the mucous membrane by fungi and the disruption of the defense mechanisms of the respiratory epithelium. In invasive forms, the mycelium penetrates deep into tissues and blood vessels, which can result in necrosis.

Nasal mycosis – symptoms

The clinical presentation of nasal mycosis depends on the form of the disease and the degree of advancement of the inflammatory process. In the initial stages, symptoms are often non-specific, which complicates early diagnosis.

The most common symptoms include:

chronic nasal obstruction (feeling of stuffiness),
nasal discharge – often thick, foul-smelling, sometimes blood-stained,
pain or a feeling of pressure within the paranasal sinuses,
reduced or lost sense of smell (anosmia),
itching and burning of the nasal mucosa.

In more advanced forms, the following may occur:

facial tissue swelling,
orbital pain,
visual disturbances,
systemic symptoms, such as fever or weakness.

The invasive form, especially in immunocompromised patients, can progress rapidly and lead to tissue necrosis and the spread of infection to adjacent structures, including the brain. In diagnostics, imaging tests (CT, MRI) as well as microbiological and histopathological examinations are of key importance.

Nasal mycosis – home remedies

Home management of nasal mycosis is purely supportive and does not constitute an alternative to causative treatment. However, it may play a role in alleviating symptoms and improving the function of the mucous membrane.

The most commonly used methods include:

nasal irrigation with saline or hypertonic solutions – support the cleansing of the nasal cavity and the removal of secretions,
air humidification – improves mucociliary function,
avoiding irritants (tobacco smoke, air pollution),
supporting the body's immunity through a diet rich in vitamins (A, C, D) and microelements (zinc, selenium).

It should be emphasized that the use of substances with potential antifungal activity (e.g., essential oils) within the nasal cavity is associated with a risk of irritation to the mucous membrane and is not supported by medical standards. In the case of persistent symptoms, a medical consultation is necessary.

Nasal mycosis – treatment

Treatment of nasal mycosis depends on the form of the disease, its severity, and the patient's general condition. Management is multi-stage and includes pharmacological therapy and – in selected cases – surgical treatment.

1. Pharmacological treatment:

antifungal drugs (e.g., azoles – itraconazole, voriconazole),
topical treatment in the form of nasal preparations,
therapy of coexisting diseases (e.g., glycemic control in diabetes).

2. Surgical treatment:

In the case of a fungus ball or invasive forms, the following are used:

endoscopic sinus clearing (FESS – Functional Endoscopic Sinus Surgery),
removal of altered tissues,
improvement of sinus drainage.

3. Supportive management:

regular nasal irrigation,
laryngological check-ups,
monitoring of potential complications.

In clinical practice, the restoration of proper mucosal function and the microbiome is also of increasing importance. Treatment should be conducted under the strict supervision of a specialist (an otolaryngologist or an infectious disease specialist), particularly in the case of patients from risk groups.