Abstract

Background: The treatment of choice for maxillary fungal ball (FB) is surgical removal; however, surgeons hesitate to perform surgery, especially in elderly individuals, under general anesthesia (G/A). So instead of G/A, this study evaluated the outcome of FB removal under local anesthesia (L/A).

Methods: Three analyses were included in this study. First, the demographic characteristics of patients with FB were analyzed via a retrospective chart review of 3,681 individuals who underwent otolaryngologic surgery; FB, chronic sinusitis (CRS), chronic otitis media, deviated septum, and enlarged tonsil. Second, the clinical characteristics of patients who had surgery for FB under L/A were compared to those of patients who had surgery for CRS under L/A via age-sex matched case-control analyses. Third, the clinical characteristics of elderly patients with FB were compared to those of non-elderly patients.

Results: Comparisons within the otorhinolaryngological disease group showed that patients with FB were older and had a higher proportion of women than the other groups. Age- and sex-matched case-control analyses with the CRS group revealed that FB patients complained of less pain (p = 0.05) and reported more satisfaction with L/A than the CRS group (p = 0.002). Analyses by age group showed that elderly patients with FB had lower sinonasal outcome test scores but higher Lund-Mackay scores.

Conclusion: Old age, diabetes, and hypertension, which may increase the risk for general anesthesia, are characteristic of patients with FB in this study. However, patients who underwent FB removal under L/A had relatively less pain, greater satisfaction than CRS with L/A. Thus, surgical removal under L/A is a safe, reasonable option for patients with FB.