Candida in sinuses?

[lalove]

My husband went to National Jewish & saw an ENT for chronic sinus pressure for 1 year.  The doctor reviewed his past CT & performed a sinus endoscope.  He noted some inflammation, but no infection.  As he was scoping him, I noticed on the screen, it appeared that he had an area in his sinuses that appeared as a cluster of small white patches.  I figured the doctor noticed this & assumed it was ok.  Bottom line, my husband recently developed oral thrush after many courses of abx, bursts of steroids.  He used nystatin and a week of diflucan with improvement.  The ENT @ National Jewish didn't have an answer for us, but referred him to an Allergist & told him to return to using flonase daily along with Ibuprofen 800mg 3x's/d.  He did this and the next day, felt significantly worse & developed very bad breath with what appears as possible mild oral thrush.  My husband did test positive to candida allergy in past testing.  My questions are:  Have you ever seen a case of candida overgrowth in the sinuses?  Does the white patches I mentioned above sound normal (Dr. didn't mention anything about it- now I wish I would have pointed that out).  Also please answer:If candida in the sinuses is possible, how would it be treated? Thanks!!

[National Jewish Health]

Candida (the fungus that causes thrush), along with about 40 other different fungi, can cause fungal sinusitis, both infectious and (less frequently in persons with a normal immune system) allergic fungal sinusitis.  So the answer to your question is yes, Candida, can cause sinus disease but such sinusitis is seldom associated with the oral thrush that commonly occurs with the use of oral steroids (taken by mouth or oral inhalation).

I don’t know what might be the nature of the “cluster of small white patches” you describe but do know that accurate interpretation of sinus CT’s or endoscopic findings requires a specialist’s expertise and your best bet would be to ask the ENT what he/she saw, and what you think you might have seen.

Candida in the sinuses would be treated with one or more systemic (swallowed or IV, rather than inhaled) anti-fungal drugs and, especially if the suspected diagnosis is Allergic Fungal Sinusitis, treated also (paradoxically as it may seem) with systemic steroids.

Something that is worth noting is that it is not uncommon for “sinus headaches/sinus pressure” to be erroneously attributed to sinusitis, when the cause is really migraine (or so-called “cluster”) headache.  Many of these individuals, when treated with one of a class of anti-migraine drugs called “triptans” (e.g. Sumatriptan), experience relief of their “sinus headaches”).

You and your husband may want to discuss this with his primary care physician or with the ENT physician.