When you are dealing with a chronic sinus infection, it can be frustrating because the treatment options may be less than effective for the patients suffering from the disease. What makes this a challenging condition to treat is because of the nature of the infection.
There are four subtypes of fungal infections that can infiltrate the sinuses. Fulminant fungal infections and indolent fungal infections are the chief causes of chronic and acute sinus infections. These subtypes are known to be invasive forms of fungal infections. The next subcategories are mycetoma and allergic sinus infections which are both non-invasive. Thankfully, more often than not, most fungal infections fall into the category of non-invasive fungal infections, so the treatment options are more straightforward. 
The presentation of these fungal infections also is entirely dependent on the immune status of the patients. Patients who are weaker and immuno-compromised are likely to have more severe presentations of the disease. As a result, the infections that a patient can present with can be slightly symptomatic to potentially life-threatening.
When a patient presents to the medical office complaining of a chronic sinus infection, chances are the first things a doctor will consider will be a bacterial or viral origin because these are far more likely. Most patients will go through a trial of antibiotic therapy that does not bring much relief so further workup will be required. The gold-standard study that all patients with fungal infections need to undergo would be computed tomography (CT) scans. Patients may also benefit from MRI studies to determine the intraorbital and intracranial involvement of fungal infections.
Once fungal infections are thought to be the culprit for the infection, cultures will need to be taken to determine the underlying fungus that is responsible for the infection. Aspergillus fungal infections are the main causes of non-invasive sinus infections. Simple treatment with antifungal medications should be a quick way to treat this type of infection.
Invasive sinus infections are what patients need to be more concerned. Mortality rates are as high as 50-80 percent of cases and these are more likely to be seen in immunocompromised patients who suffer from poorly controlled diabetes mellitus, those on chemotherapy, or those patients using steroids.
This is a condition of rapid deterioration in patients. Patients will suffer from periorbital edema, ptosis, and eventual vision loss if their problem is not corrected as quickly as possible. The infection will soon spread to the brain if it is not taken care of and some of the first symptoms will be altered mental status. Patients will need to have urgent IV antibiotic, and antifungal therapy and patients may also need surgery to remove infections in the skull. 
Patients may avoid long-term risks of fungal infections with this invasive intervention but the best way to rid yourself of the risk entirely would be to try to improve their immune system. Patients with HIV need to have anti-HIV therapy to improve CD4 count; diabetes should be controlled to remove complications and patients with chemotherapy need to be monitored closely to make sure fungal infections are less likely from occurring.
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