A 40-year-old immunocompetent woman presents with chronic unilateral facial fullness without nasal polyposis. CT shows a completely opacified right maxillary sinus with central hyperdense material suggestive of calcification and intact bony walls. Endoscopy is normal. What is the most appropriate management?

• A Systemic corticosteroids with prolonged antibiotics
• B Endoscopic middle meatal antrostomy with complete removal of the inspissated content ✓
• C Liposomal amphotericin B followed by serial imaging
• D Radical maxillectomy via Caldwell-Luc approach

Explanation

This is a fungus ball, a noninvasive fungal sinusitis typically involving one maxillary sinus in an immunocompetent host. CT shows a single opacified sinus with central calcification and intact bone. Treatment is surgical evacuation through an endoscopic middle meatal antrostomy; histopathology confirms fungal elements without tissue invasion, so antifungals are unnecessary. Radical Caldwell-Luc surgery is obsolete for this condition, and steroids have no role because there is no type 2 inflammation.

Reference: Scott-Brown's Essential Otorhinolaryngology, 3rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.