Predictors of Pain in Patients with Noninvasive Fungal Sinusitis

The number of cases of noninvasive fungal sinusitis among asymptomatic and older patients has recently increased. Older adults are more commonly predisposed to comorbidities than younger people, and it is often difficult to determine a treatment plan for such patients, particularly for asymptomatic patients. Notably, surgery is the first-choice treatment for such patients; however, to date, no clear guidelines have been established for the same. In this study, we investigated the predictive factors of pain among patients with noninvasive fungal sinusitis. Out of 554 patients who underwent endoscopic sinus surgery between April 2010 and March 2020 at the Yokohama City University Medical Center, 59 were diagnosed with fungal sinusitis based on the identification of fungi in resected surgical specimens. Of these, 19 patients with preoperative symptoms, such as headache and facial pain, were included in the pain group, whereas the remaining 40 patients were included in the control group. Overall, 18 items were analyzed, including patient background factors, preoperative computed tomography scan results, blood test results, the location of the fungal mass, and information on the identified fungal species. Univariate analysis revealed significant differences in age, alcohol consumption, frequency of occurrence of ethmoid and frontal sinus lesions, Lund–Mackay scores, and white blood cell counts between the pain and control groups. However, based on multivariate analyses, only the Lund–Mackay score and white blood cell counts were identified as independent predictors of pain. In the receiver operator characteristic curve analysis, the area under the curve for the Lund–Mackay score was 0.76, and sensitivity and specificity were at a maximum cutoff score of 5. Among patients with noninvasive fungal sinusitis, those with high Lund–Mackay scores or white blood cell counts should be considered candidates for surgery.