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BackTable / ENT / Podcast / Episode #164

Chronic Invasive Fungal Sinusitis: Diagnosis & Management

with Dr. Ashleigh Halderman

In this episode, Dr. Ashleigh Halderman, Rhinologist and Associate Professor at the University of Texas Southwestern Medical Center, discusses chronic invasive fungal sinusitis with hosts Dr. Gopi Shah and Dr. Ashley Agan,

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Chronic Invasive Fungal Sinusitis: Diagnosis & Management with Dr. Ashleigh Halderman on the BackTable ENT Podcast)
Ep 164 Chronic Invasive Fungal Sinusitis: Diagnosis & Management with Dr. Ashleigh Halderman
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BackTable, LLC (Producer). (2024, March 26). Ep. 164 – Chronic Invasive Fungal Sinusitis: Diagnosis & Management [Audio podcast]. Retrieved from

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Podcast Contributors

Dr. Ashleigh Halderman discusses Chronic Invasive Fungal Sinusitis: Diagnosis & Management on the BackTable 164 Podcast

Dr. Ashleigh Halderman

Dr. Ashleigh Halderman is an Assistant Professor and practicing ENT specializing in rhinology and skull base surgery in the Department of Otolaryngology at UT Southwestern in Texas.

Dr. Ashley Agan discusses Chronic Invasive Fungal Sinusitis: Diagnosis & Management on the BackTable 164 Podcast

Dr. Ashley Agan

Dr. Ashley Agan is an otolaryngologist in Dallas, TX.

Dr. Gopi Shah discusses Chronic Invasive Fungal Sinusitis: Diagnosis & Management on the BackTable 164 Podcast

Dr. Gopi Shah

Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.


First, Dr. Halderman outlines her advocacy work as President of the Texas Association of Otolaryngology. Then, the discussion transitions to chronic invasive fungal sinusitis. Dr. Halderman defines the disease, describes typical patient presentation, and reviews concerning imaging findings. Until biopsy can clinch the diagnosis, she maintains a high index of suspicion in cases of bizarre clinical presentation or facial paresthesia. The surgeons then shift their attention to management, which consists of culture-directed antifungals and judicious surgical intervention. Dr. Halderman wraps up the episode by sharing her pearls for operative management and long-term surveillance.


00:00 - Introduction
02:10 - Exploring the Texas Association of Otolaryngology
05:58 - Understanding Chronic Invasive Fungal Sinusitis: Types & Treatments
20:25 - Diagnostic Challenges and Imaging Insights
27:07 - Navigating Diagnostic Challenges and Treatment Options
29:40 - The Role of Biopsy in Confirming Fungal Infections
30:52 - Surgical Considerations and Pre-Operative Strategies
40:29 - Surveillance Strategies: Managing Chronic Invasive Fungal Sinusitis
46:34 - The Future of Surgical & Antifungal Therapies for Chronic Invasive Fungal Sinusitis


Dr. Ashleigh Halderman’s UT Southwestern Profile:

BackTable ENT Episode 30, “Revision Endoscopic Sinus Surgery"

Texas Association of Otolarynogology:

Transcript Preview

[Dr. Ashley Agan]
In patients who are presenting with predominantly like a facial pain complaint, I feel like it would be very easy to miss this because it's so rare that most of us probably aren't thinking of chronic invasive. Because patients coming in with sinus headache and facial pain are pretty common, and the percentage of them that are experiencing a chronic invasive fungal sinusitis is probably very, very low. Also you don't want to miss this. Any other questions that help tip you off, or is it just the chronic worsening nature of it? Walk me through your clinic visit to where we can make sure that we're catching these. Because these are mostly presenting in the clinic, not in the hospital, like an acute, right?

[Dr. Ashleigh Halderman]
No. The ones that I've seen have all presented in the hospital actually. It's because unfortunately by the time they get to us is they've gone blind, or they've developed some type of orbital symptoms, if you will, or the imaging is very concerning for like a mass or a tumor. That's how they typically end up with us. If you were just going off of facial pain alone, it is difficult and you're right, the majority of those patients are not going to have chronic invasive fungal sinusitis. Again, if they don't have any possible immune deficiency, like they're not diabetic, they haven't been on steroids, all of these things, then that further sort of is like probably not the case.

Disclaimer: The Materials available on are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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