Otolaryngology Case Reports · Published 2025-11-18 · DOI 10.1016/j.xocr.2025.100715
Fungal sinusitis is a common otolaryngological disease; however, most cases involve the maxillary sinus, and cases of isolated fungus balls (FBs) in the frontal sinus are extremely rare. Herein, we describe the management of an isolated frontal sinus FB in a patient without underlying immunodeficiency. A 58-year-old man presented with a 1-month history of pain in his left forehead. Sinus computed tomography (CT) showed soft-tissue shadows with calcification in the left frontal sinus, and magnetic resonance imaging showed low signal intensity on T2-weighted images at the site of calcification on CT, suggesting the presence of an FB. The patient had a relatively severe and unique anatomical condition that appeared challenging to manage. The endoscopic modified Lothrop procedure (EMLP) was selected, and surgery was performed 3 months after the initial visit. An inside-out approach was used to reach the frontal sinus and unify the bilateral frontal sinuses into a single cavity. A powered irrigation system was used to irrigate and completely remove the entire fungal mass. The pathological findings showed clusters of Aspergillus. In summary, the EMLP was successfully performed, and the FB was completely removed without any complications in this case. The patient remains recurrence-free to date, and the wound site is easily observable via a fiberscope.
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