<prompt> Which among the following is true regarding fungal sinusitis -a Surgery is required for treatmentb Most common organism is Aspergillus nigerc Amphoterecin B i.v is used for invasive fungal sinusitisd Hazy appearance on X-ray with radio-opaquee Seen only in immunodeficient conditionsacdadbcbde  <response>: Fungal SinusitisMost common cause: AspergillusMost common species: A. fumigatus 90 A. niger A. flavus.Other offenders are: Mucor, Rhizopus, AlternariaFungal infection can be of following types:i. Fungus ballii. Allergic fungal rhinosinusitisiii. Chronic or indolent invasive fungal sinusitisiv. Acute fulminant fungal rhinosinusitisFungus BallFungus ball occurs in adults femalesMC agent: AspergillusMost common sinus involved Maxillary sphenoid sinusMC symptom unilateral postnasal dischargeMost Important Investigation-CT scanFungus ball is the main fungal rhinosinusitis in an immunocompetent patient.Surgery FESS is the most effective treatment for fungus ball.Allergic Fungal RhinosinusitisAFS is a noninvasive fungal rhonosinusistisDermatiaceous species are the fungal agents mostly responsible for AFRs.Seen in immunocompetent hosts with allergy to fungus.Clinical and biological criteria for diagnosis is still under debate, and include nasal polyps, thick mucin, hypersensitivity type I for fungus, eosinophilic mucin.Sinus opacities with bone extension are frequently seen on CT scan.Diagnosis of all allergic fungal rhinosinusitis is supported by allergic and fungal criteria Refer to Ans. 11 for criteria.Treatment AntifungalsChronic or Indolent Invasive Fungal RhinosinusitisChronic invasive fungal rhinosinusitis is a rare pathology occurring mostly in immunocompetent patients.Aspergillus is the most frequent agent isolated in this pathology.Acute Fulminant Fungal RhinosinusitisFulminant invasive fungal rhinosinusitis occurs in immunocompromised patients HIV, diabetes, chemotherapyEarly diagnosis and control of primary immunological disorders is essential for the prognosis.Thus from the above description it can be concludedOption a Surgery is required for treatment correct as in all forms of fungal sinusitis some or the other form of surgery is required.Option b Mc organism is Aspergillus niger.Incorrect Mc is A. fumigatusOption c Amphotericin IV is used for invasive fungal sinusitisCorrectOption d Hazy appearance on X-ray with radiopaque densityCorrect Sinusitis gives hazy appearance on X-rayOption e Seen only in immunodeficient conditionIncorrect only the acute fulminant form is more common in immunodeficient state whereas others are seen in immnocompetent hosts. 