48-Year-Old Male Patient Recovered from Chronic Aspergillosis of Paranasal Sinuses

Abstract

Background: Chronic aspergillosis of the paranasal sinuses, frequently associated with Aspergillus fumigatus or A. flavus, often requires surgical intervention along with antifungal therapy. In Ayurveda, comparable pathology is explained under Dushta Pratishyaya, characterized by obstruction, infection, and Kapha dominance, causing impaired sinus drainage. Exploring non-surgical Ayurvedic management offers clinical value, particularly in immunocompetent individuals.

Objective: To document the clinical and radiological outcomes of an Ayurvedic treatment protocol in a 48-year-old immunocompetent male diagnosed with chronic maxillary sinus aspergilloma.

Materials and Methods: The patient reported a three-month history of nasal obstruction, snoring, headache, and right maxillary swelling. NCCT PNS (22 May 2019) confirmed right maxillary aspergilloma with mild sinusitis and an S-shaped deviated nasal septum. Treatment included Nasya karma with Anu Taila, internal herbal medicines (Changeri swarasa, Arogyavardhini Vati, Gandhaka Rasayana, Satyanashi swarasa), steam inhalation with Neem and Tulsi, and later Rasayana support (Brahma Rasayana, Bhumiamla Swarasa, Bhasma-based immune restoratives). Progress was monitored through NCCT scans at defined intervals.

Results: Significant improvement was observed in nasal airflow, facial pain, and discharge. Repeat NCCT on November 14, 2019, showed contraction of the pathological soft tissue mass. The final NCCT on 30 May 2020 demonstrated a small, well-defined, lobulated soft tissue residual, interpreted as healed post-infective changes, with no progression. No surgical or systemic antifungal therapy was required during the management period.

Conclusion: This case demonstrates that an individualized Ayurvedic regimen focusing on Nasya and Kapha-Shodhana principles can achieve symptomatic and radiological improvement in chronic fungal sinusitis in an immunocompetent patient, avoiding surgical intervention. Controlled clinical studies are needed in the future by researchers to further validate this approach.

Keywords: Aspergilloma, Fungal Sinusitis, Dushta Pratishyaya, Nasya, Paranasal Sinuses, Ayurveda.

Introduction

Fungal sinusitis accounts for approximately 6- 9% of all rhinosinusitis cases. The most commonly affected sinus is the maxillary sinus, with Aspergillus species being frequent pathogens (A. fumigatus followed by A. flavus). It is a difficult condition to treat. These infections can present in different forms, from non-invasive fungal balls (aspergilloma) to slowly progressive or fulminant invasive disease.

The paranasal sinuses provide a warm, relatively enclosed, and poorly ventilated environment that can favor fungal growth if sinus drainage is compromised or host defenses are weakened. Patients may present with nasal blockage, facial pain or swelling, purulent or odorless discharge, headache, impaired smell, and other chronic sinus symptoms.

Although many cases occur in immunocompromised patients, for example, those on corticosteroids, with neutropenia, diabetes, or transplant recipients, there is increasing recognition that even immunocompetent individuals can develop sinus aspergillosis under favorable local conditions such as anatomical deviation, impaired ventilation, or retained mucus.

Radiologically, the disease may show soft‐tissue masses in the sinus cavity, areas of calcification, bone erosion, or sinus opacification; these changes reflect either non-invasive fungal balls or more aggressive invasive forms. Modern management typically involves surgical debridement combined with systemic antifungal therapy in the more aggressive forms; for fungal balls, surgery plus restoration of drainage is often standard.

So, in most cases, ENT management involves surgical removal of the fungal mass along with antifungal medicines. Even after surgery, patients may experience recurrence, facial pain, nasal blockage, and impaired breathing. When the patient is otherwise healthy and immunocompetent, a safe and effective non-surgical treatment option becomes very important.

As per Ayurveda, chronic sinus pathology with blocked nasal passages, stagnated mucus, heaviness of head, and facial swelling corresponds to the syndrome of Dushta Pratishyaya, i.e., chronic nasal or sinus inflammation with vitiated doshas and deranged channels (Strotorodha).

In this condition, Kapha dosha often predominates, leading to obstruction of the nasal and sinus Strotas (channels), retention of secretions, and subsequent secondary involvement of Vata and Pitta. The stagnation of Kapha and loss of normal ventilation predispose to repeated infection and deep-seated involvement. If not treated properly in the early stages, the disease becomes chronic and more stubborn.

Ayurvedic classics mention that to treat diseases of the head and nose, the most direct treatment is Nasya, as Nasa Hi Sirso Dwaram, where medicated oil or formulations are administered through the nostrils. It helps to clear the channels, reduce inflammation, improve drainage of the sinuses, and strengthen local immunity.

Along with Nasya, internal herbal medicines that reduce Kapha, improve metabolism, and support tissue repair are also recommended. Rasayana therapy further helps in building strong immunity and preventing disease recurrence.

Case Presentation

A 48-year-old male patient presented to the outpatient clinic of IAFA on 8 August 2019 with a history of nasal obstruction, mouth-breathing, snoring, headache, swelling, and pain in the right maxillary region. The symptoms had been present for three months and had worsened over the two weeks before the visit.

NCCT of the paranasal sinuses performed on 22 May 2019 revealed a right maxillary sinus intra-orbital and pre-/retro-antral soft tissue mass consistent with an aspergilloma, along with mild sinusitis and a deviated nasal septum. The patient was immunocompetent with no history of diabetes, TB, asthma, or immunosuppressant use. Based on clinical and radiological findings, the Ayurvedic diagnosis of Dushta Pratishyaya with Kapha predominance was made, and an Ayurvedic therapy regimen was initiated.

1. Patient Details

Age / Gender: 48 Years / Male.

Address: Haryana, India

Date of first Consultation: 8 August 2019

Presenting symptoms: Nasal obstruction, mouth breathing, snoring, headache, pain, and swelling in the right maxillary region, scanty Seropurulent, odorless nasal discharge.

Symptom duration: Three months overall, aggravated over the last two weeks.

Vital/general status: No systemic illness. Immunocompetent by history (normal chest X‐ray, HIV negative, no diabetes mellitus, no corticosteroid use) and normal hematology/renal/liver functions.

Anatomical findings: Right‐sided nasal septum deviation (‘S’ shaped) and tenderness/swelling in the right maxillary region on physical examination.

2. Primary Complaints

Persistent nasal blockage on the right side and mouth-breathing, especially at night.
Snoring interferes with sleep.
Headaches, particularly in the frontal or maxillary region, and swelling or pain in the right maxillary region.
Scanty odorless Seropurulent discharge from the right nasal cavity.

3. Medical History

No history of tuberculosis, asthma, chronic sinusitis, or recurrent upper respiratory infections.
No history of prolonged antibiotic use, corticosteroid therapy, or known immunosuppressant use.

Laboratory investigations: Hematological, renal, and liver function tests were within normal limits. Urine showed no protein or glucose, cultures were sterile, and the chest X-ray was normal.

4. Diagnosis

Radiological diagnosis: NCCT PNS (22 May 2019) revealed right intra-orbital and pre-/retro antral soft tissue suggestive of a right maxillary aspergilloma, mild right maxillary sinusitis, and an ‘S’ shaped deviated nasal septum.

Ayurvedic diagnosis: Based on the persistent nasal and sinus symptoms, Kapha predominance, i.e., nasal obstruction, heaviness, mucous discharge, and local swelling or obstruction of drainage channels, the condition was diagnosed as Dushta Pratishyaya with Kapha predominance.

Final diagnosis: Chronic aspergillosis of the right maxillary sinus (fungal ball or aspergilloma) in an immunocompetent patient with anatomical nasal septum deviation contributing to impaired drainage and sinus stasis. (Dushta Pratishyaya).

Method

1. Intervention Protocol

The patient received an Ayurvedic intervention combining external and internal treatment, i.e., local nasal therapy (Nasya), internal Kapha- Shamaka and metabolism-correcting formulations, and Rasayana (rejuvenation) support. The protocol was planned to improve sinus drainage, reduce fungal load, relieve inflammation, and restore immune strength. Follow-up NCCT imaging was used to monitor progress.

2. Ayurvedic Diagnostic Framework

Based on the symptoms of nasal obstruction, heaviness of head, sticky discharge, swelling, and chronic progression, the disease was classified as Kapha-Pradhana Dushta Pratishyaya, involving vitiation of Kapha and Vata, with localized Strotorodha, i.e., obstruction of drainage channels of the Urdhva Jatru region.

Table 1: Samprapti Ghataka (Pathogenesis Factors)

Samprapti Ghataka (Component)	Interpretation
Dosha	Kapha dominant, which may result in mucus stagnation with Vata Dosha association, causing pain and obstructed airflow.
Dushya	Rasa, Rakta, Mamsa showing mucosa and sinus lining involvement
Srotas	Pranavaha Strotas
Srotodushti	Sanga (blockage) due to a fungal mass and DNS
Agni	Mild Manda Agni, which results in delayed recovery, and an Ama tendency in the patient.
Udbhava Sthana	Amasaya
Adhisthana	Right maxillary sinus
Vyaktasthana	Nose and paranasal sinus
Roga Marga	Bahya Marga

3. Ayurvedic Treatment Protocol

Treatment started on 8 August 2019 and continued in a phased manner.

Nasya Karma with Anu Taila directly delivers medicines to the affected sinus region and clears obstructed passages.
Internal medicines targeting Kapha-Vata reduction, detoxification, mucolysis, and antimicrobial action, i.e., Changeri Swarasa, Satyanashi Swarasa, Arogyavardhini Vati, Gandhaka Rasayana.
Steam inhalation with Neem and Tulsi to enhance drainage and reduce infection.
Rasayana formulations, i.e., Brahma Rasayana, Bhumiamla Swarasa, supportive Bhasmas like Abhraka Bhasma, Yashada Bhasma, to improve mucosal immunity, prevent recurrence, and accelerate healing.

Diet and Lifestyle Advice (Pathya and Apathya)

Warm, easily digestible, Kapha-reducing diet, like light soups, warm water, and the use of ginger or black pepper in meals.
Avoid cold drinks, curd, bananas, refined sugary, or excessively oily food.
Steam inhalation continued regularly.
Sleep position with head elevation at night.
Avoid exposure to dust and damp places.
Breathing exercises to improve nasal ventilation.

4. Ayurvedic Treatment Follow-Up Protocol

Table 2: Treatment follow-up protocol

Phase	Formulation	Dose	Frequency	Route	Purpose
Phase 1 (08-08-2019 to 10-11-2019)	ChangeriSwarasa	30 ml	Twice daily	Oral	Kapha-Vata reduction, mucosal healing
	Arogyavardhini Vati	500 mg	Twice daily	Oral	Liver and metabolism correction
	Gandhaka Rasayana	500 mg	Twice daily	Oral	Rasayana and anti-infective
	Satyanashi Swarasa	60 ml	Twice daily	Oral	Kapha- Shamaka, antimicrobial
	Anu Taila Nasya	6–8 drops	Once daily	Nasal	Local channel cleansing
	Neem and Tulsi steam	—	Once or twice daily	Inhalation	Improve sinus drainage
Phase 2 (22-11-2019 to 22-03-2020)	Brahma Rasayana	2 tsp	Twice daily	Oral	Act as Rasayana, immune restoration
	Tab. Livomyn	500 mg	Twice daily	Oral	Supports detoxification, clears toxins
(Continued others as above)	–	–	–	–	Healing support
Phase 3 (22-03-2020 to 30-05-2020)	Bhumiamla Swarasa	10 ml	Twice daily	Oral	Anti-inflammatory, mucosal repair
(Continued others as above)
Phase 4 (11-06-2020 to 11-07-2020)	Sitopaladi Churna	3 gm	Twice daily	Oral	Cough or mucus management
	Abhrak Bhasma	125 mg	Twice daily	Oral	Respiratory Rasayana
	Yashad Bhasma	125 mg	Twice daily	Oral	Immunomodulatory
	Swarasa-Tulsi Panchanga, Ashwagandha Root, Sheerisha Root	10 ml each	Twice daily	Oral	To attain complete recovery by improving the immune system and to add rejuvenation.

All formulations given externally in the case were reviewed and adjusted based on symptom changes and imaging progression.

Results

1. Symptomatic Outcome

The patient reported significant improvement in nasal obstruction, mouth-breathing, and snoring over the treatment period.
Swelling and pain in the right maxillary region reduced substantially.
Scanty sero-purulent, odorless discharge from the nasal cavity diminished and eventually became negligible.
Headache, i.e., mainly in the frontal or maxillary region, also subsided, improving the patient’s sleep quality and general comfort.
The patient avoided surgical intervention and systemic antifungals, as reported while achieving relief with Ayurvedic treatment.

2. Radiological Outcome

Baseline (22-05-2019): NCCT PNS showed right intra-orbital and pre-/retro-antral soft tissue mass in the right maxillary sinus suggestive of an aspergilloma, mild right maxillary sinusitis, and a “S-shaped” deviated nasal septum.

First follow-up (14-11-2019): NCCT PNS revealed persistent right intra-orbital/pre-antral soft tissue, bilateral maxillary and right sphenoid mild sinusitis, and the same deviated nasal septum. There was a noted reduction in the intensity of the lesion compared to baseline, as per the description given in the report.

Final follow-up (30 May 2020): NCCT PNS showed small, well-defined lobulated soft tissue along the superior, anterior, and lateral walls of the right maxilla. No interval changes as compared to the previous CT, which suggested healed changes. Mild bilateral maxillary and right sphenoidal sinusitis remained, and the S-shaped DNS persisted.

Interpretation: The steady reduction and stabilization of the lesion, with residual defined soft tissue rather than an active, diffuse mass, consistent with healing or post-infective change rather than ongoing active disease.

3. Summary of Outcomes

In summary, we can conclude that the patient achieved both clinical improvements, i.e., symptoms relieved and structural improvement, i.e., radiological evidence of regression, and stabilized residual changes over approximately 10 months of Ayurvedic management. The avoidance of surgery or systemic antifungals in this case strengthens the significance of the outcome.

Discussion

This single case report describes the Ayurvedic management of chronic aspergillosis of the paranasal sinuses in an immunocompetent 48-year-old male, where the usual modern approach would strongly lean towards surgical removal of the fungal ball or aspergilloma, along with antifungal therapy.

In contrast, the patient here was managed non-surgically with an individualized Ayurvedic protocol that included Nasya karma, internal Kapha-Shamaka and Rasayana formulations, steam inhalation, and diet-lifestyle regulation, monitored with serial NCCT imaging.

Over approximately 10 months of treatment and follow-up, the patient showed consistent symptomatic improvement and radiological regression to a small, stable, well-defined residual lesion interpreted as healed changes, without progression or invasive features.

1. Pathophysiological Understanding

From a modern perspective, fungal sinusitis occurs when fungal spores colonize the paranasal sinuses, especially the maxillary sinus, in a locally favorable environment, i.e., poor ventilation, impaired mucociliary clearance, anatomical obstruction, e.g., deviated nasal septum, and retained secretions. Over time, a dense fungal ball (aspergilloma) can form, with surrounding mucosal inflammation and sometimes bone changes. Even in immunocompetent individuals, chronic obstruction and stasis can sustain fungal growth and recurrent symptoms.

As per Ayurveda, these diseases pattern closely overlap with Kapha-Pradhana Dushta Pratishyaya, in which Kapha Dosha results in heaviness, mucous accumulation, obstruction, swelling, Vata Dosha results in pain, dryness in deeper tissues, disturbed airflow, and Pitta Dosha secondary results in low-grade inflammation, irritation.

Table 3: Phase-Wise Therapeutic Protocol

Phase	Clinical Focus	Main Strategy	Expected Effect
Phase 1	Active symptoms	Kapha-shamana and Srotoshodhana	Symptom relief, sinus drainage
Phase 2	Reduced lesion, persistent stasis	Continuation of the same treatment and Rasayana introduction	Healing support, better defense
Phase 3	Radiologic healing trend	Rasayana use and mucosal repair	Structural restoration
Phase 4	Residual lesion	Rasayana intensification	Recurrence prevention, immunity boost

2. Pharmacological Action of Formulations Use

Formulation / Drug	Key Pharmacological Actions	Ayurvedic Actions	Clinical Relevance
Anu Taila (Nasya)	Local anti-inflammatory, mucolytic, improves mucosal lubrication and drainage.	Strotoshodhaka, Vata- Kapha Hara, Shiro- Roga Nashaka, strengthens organs above the clavicle (Urdva Jatrugata)	Directly targets the nasal and sinus mucosa, reduces blockage, promotes drainage of fungal mass and secretions, and relieves headache and heaviness.
Changeri Swarasa (Oxalis corniculata)	Reported antioxidant, anti-inflammatory, mild antimicrobial, and digestive stimulant	Deepana, Pachana, Kaphaghna, support Grahani and metabolism	Improves Agni (digestive fire), reduces Kapha and Ama, indirectly supports sinus clearance by correcting systemic digestion and metabolism.
Satyanashi Swarasa (Argemone mexicana)	Reported as antimicrobial, anti-inflammatory, and in some reports, active against pathogens.	Tikshna, Katu, Kaphaghna, Krimighna	Help in reducing microbial or fungal load and thick secretions.
Arogyavardhini Vati	Hepatoprotective, lipid-modulating, digestive, or metabolic regulator in several studies	Deepana, Pachana, Lekhana, Kaphapittahara	Helpful in correcting liver and GI function, reducing Ama, and reversing the internal environment favoring chronic inflammation OR infection.
Gandhaka Rasayana	Antimicrobial, immunomodulatory, anti-inflammatory, skin and mucosal healing support	Rasayana, Krimighna, Kushtaghna, Vrana ropaka	Acts as a systemic Rasayana and antimicrobial support. Strengthens local and systemic defense, aids tissue repair in infected sinus mucosa.
Brahma Rasayana	Antioxidant, adaptogenic, neuro-immune supportive (based on its rich herbal composition)	Medhya Rasayana, Balya, Ojo-Vardhaka	Improves overall vitality, immunity, and recovery. Supports long-term stability and prevents recurrence.
Livomyn	Polyherbal liver-support formulation- reported hepatoprotective and detoxifying actions.	Yakrit- Uttejaka, Deepana, Pachana, Raktashodhaka	Corrects suspected Manda Agni and hepatic or metabolic load, improving systemic detoxification and immune support during chronic disease.
Bhumiamla swarasa (Phyllanthus niruri)	Reported hepatoprotective, anti-inflammatory, antiviral, antioxidant effects	Pittaghna, Rakta-Shodhaka, supports Agni without aggravating Pitta	Adds gentle detox and anti-inflammatory support during the healing phase, protects the liver under long medication courses, and aids tissue repair.
Sitopaladi Churna	Expectorant, mild bronchodilator, and anti-allergic activity reported. It is used widely in chronic respiratory conditions.	Kaphaghna, Kasahara, Pranavaha Strotas Shodhaka	Help clear upper airway secretions, relieve cough or throat irritation, and complement sinus drainage.
Abhraka Bhasma	Traditionally regarded as Rasayana for respiratory and systemic tissues. Some data suggest adaptogenic and hematinic effects.	Rasayana, Vayahsthapana, Pranavaha Poshana	Supports respiratory tissues, improves the resilience of sinus mucosa, and deeper Pranavaha Strotas.
Yasad Bhasma (Jasad)	Zinc-based, modern zinc known for immune support, epithelial repair, and antiviral support	Rasayana, Vrishya, Ropana	Enhances mucosal healing and local immune function, reducing the risk of recurrent infection in the sinus region.
Neem and Tulsi steam inhalation	Neem: antimicrobial, anti-inflammatory, and Tulsi: antimicrobial, immunomodulatory, mucolytic action.	Krimighna, Kaphaghna, Sroto- Shodhaka	Direct topical antimicrobial and mucolytic effect in the nasal passages, synergistic with Nasya for better clearance.

Conclusion

This single case study highlights the potential of an individualized Ayurvedic approach as a safe and effective non-surgical management option for chronic aspergillosis of the paranasal sinuses in an immunocompetent patient.

The Ayurvedic treatment protocol, including Nasya karma, Kapha-reducing internal medicines, steam inhalation, and Rasayana therapy, led to significant symptomatic relief and radiological improvement over the course of management. The lesion regressed to a stable healed state without the need for surgical intervention or systemic antifungal therapy.

Consult Online with Dr. Sahil Gupta (B.A.M.S., M.H.A.)

While the findings cannot be generalized from a single case, the positive outcome supports further investigation of integrative Ayurvedic treatment in chronic fungal sinus disease. Controlled clinical studies with objective scoring and microbiological confirmation are recommended to validate the role of Ayurveda in similar conditions.

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