LAUSR

AIMS The incidence of fungal sinusitis is increasing; however, its pathophysiology has not been investigated previously. This study investigated the effect of periodontitis on the incidence of fungal sinusitis over a 12-year follow-up period using nationwide, population-based data. MATERIALS AND METHODS The periodontitis group was randomly selected from the National-Health-Insurance-Service database. The non-periodontitis group was obtained by propensity score matching considering several variables. The primary end point was the diagnosis of sinonasal fungal balls and invasive fungal sinusitis. RESULTS The periodontitis and non-periodontitis groups included 12442 and 12442 individuals, respectively. The overall adjusted hazard ratio (aHR) for sinonasal fungal balls in the periodontitis group was 1.46 (p=0.002). In subgroup analysis, the aHR for sinonasal fungal balls was 1.59 (p=0.008) for those with underlying chronic kidney disease (CKD), 1.58 (p=0.022) for those with underlying atopic dermatitis, 1.48 (p=0.019) for those with chronic obstructive pulmonary disease (COPD), and 1.36 (p=0.030) for those with diabetes mellitus (DM), but these values are only applicable when considering the relationship between periodontitis and SFB. The aHR for invasive fungal sinusitis (IFS) in the periodontitis group was higher than in the non-periodontitis group (2.80; p=0.004). CONCLUSIONS The risk of sinonasal fungal balls and IFS increased after diagnosis of periodontitis. This trend is often more severe in patients with DM, COPD, or CKD, but this association with underlying diseases is only applicable when considering the association between periodontitis and fungal sinusitis.