Allergy, Nose & Sinus

Headaches from fungus in the sinus! (WARNING – GRAPHIC MEDICAL IMAGES!)

February 10, 2020
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Dr Gan saw a patient, Ms A, an 18 year old lady who complained of a few months history of constant heaviness and headaches in the central/back part of her head. She also suffered from a left sided blocked nose and frequent postnasal drip. She has been coughing out clumps of brown material that she wasn’t sure of its significance. She has had multiple courses of oral antibiotics which failed to resolve her symptoms.


On nasaoendoscopy, there was mucopus (nose mucous mixed with some pus) in her left nasal cavity. This was suctioned in the clinic and revealed a large polyp occupying most of the left nasal cavity.




Mucous and some pus filling up most of the left nasal cavity



Left nasal polyp

After suctioning the mucopus, a large polyp can be seen



As her nasal polyp was unilateral (one sided), a CT scan scan of the sinus and a biopsy of the nasal polyp was performed to rule out a tumour. The CT scan showed complete blockage of the left sphenoid sinus (the sinus behind the eyes, close to the brain). The appearance of the CT scan  suggested a possible fungal concretions in her left sphenoid sinus. The biopsy of the nasal polyp was consistent with an inflammatory polyp (non tumour).



CT Scan Head

A CT scan of the head (axial cut) showing complete opacification (blockage) of the left sphenoid sinus



Ms A underwent a left functional endoscopic sinus surgery (FESS) to remove the inflammatory polyp and to drain her blocked left sphenoid sinus. During surgery, fungal concretions (clumps of fungus) was found stuck and completely filling up the left sphenoid sinus. This was removed.


Left Sphenoid Sinus

Fungal ball (fungal concretions) in the left sphenoid sinus during surgery



Fungal Ball

Fungus removed from the nose



Fungus removed from the nose



The mucosa (lining of the sinus) of the left sphenoid sinus was swollen and inflamed from the long standing infection. About a month after the surgery, Ms A’s left sphenoid sinus has completely healed. She no longer suffers from postnasal drip or headaches that used to trouble her.


The sphenoid sinus is one of the deepest sinus in the head. There are many important structures close to the sphenoid sinus, including the brain, nerves and large blood vessels. Hence, an infection in this sinus should be treated to prevent spread to the surrounding critical structures. We do not know why some people are prone to having a collection of fungus (commonly called Fungal Ball) in the sinus. The most common sinus where Fungal Balls occur is in the maxillary (cheek) sinus. One of the known risk factor for this is a history of previous dental procedures. Fungal Balls can be a source of secondary bacterial infection and may block the sinus completely, like in the case of Ms A. The treatment is usually surgical removal (through a minimally invasive procedure through the nose called FESS) and the clinical outcome is usually excellent.



Normal Sinuses Chart

Acute Sinusitis Illustration







    When Should You See an ENT Specialist in Singapore?

    • Any ear, nose or throat symptoms that you are troubled with or concerned about
    • Persistent blocked nose with mouth breathing or snoring

    Dr Gan Eng Cern

    Dr Gan Eng Cern is a distinguished ENT doctor with fellowship training. In addition to his clinical practice as an ear, nose and throat specialist in Singapore, Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.


    • 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
    • 2016 – Best Educator Award (Eastern Health Alliance)
    • 2016 – “Wow” Award (Patient Compliment)
    • 2014 – Eastern Health Alliance Caring Award – Silver
    • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
    • 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
    • 2007 – Singhealth Best Doctor Award


    • MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
    • MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
    • MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
    • FAMS – Fellow of the Academy of Medicine Singapore

    Why Choose Dr Gan Eng Cern


    Reliable & Reputable ENT Expert

    Experienced and patient ENT Specialist who has your best interests at heart. We aim to provide you with accessible and specialized care for any ENT condition in a comfortable setting.


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    Our friendly staff will assist you to the best of our ability and we are happy to accept most insurance providers and assist with E-filing with relevant insurance providers or Medisave.


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    Our ENT Specialist, Dr Gan Eng Cern, will be able to diagnose and offer personalised treatments for your specific ENT condition. You can expect a high level of ENT care in a spacious setting with in-house minor surgical, endoscopy, allergy testing and microscopy services.


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