Concha bullosa is the pneumatization of the concha and is one of the most common variations of the sinonasal anatomy. The histopathological changes caused by the infections which arise from the impaired aeration of conchal cavity are frequently found. Fungus ball of the nasal cavity is an extremely rare, fungal infection with only three cases reported previously. In this paper, we present the fourth fungus ball case which developed within a concha bullosa and presented with anosmia. 1. Introduction Fungus balls or mycetomas are extramucosal accumulations of degenerating fungal hyphae especially within chronically inflamed paranasal sinuses [1]. Aspergillus infections of the nose and paranasal sinuses are unusual but are being increasingly recognised in recent years. In the head and neck region, Aspergillus species can cause otomycosis, allergic paranasal sinusitis, invasive paranasal sinusitis, and aspergilloma of the paranasal sinuses [2]. In the English literature, we have found only three cases of fungus ball in concha bullosa published up to date [3]. In this case report, we describe a concha bullosa fungus ball in a 55-year-old woman. The clinical presentation, radiological and endoscopic findings, and management approach for this case are discussed. 2. Case Report A 55-year-old woman was admitted to our clinic with 2-year duration of anosmia, nasal obstruction, and headache complaints. She had no history of nasal trauma, diabetes, immunosuppressive disease, and allergies. Nasal endoscopic examination revealed purulent nasal discharge in right nasal cavity, left septal deviation, and a hypertrophic right middle concha. The patient was otherwise healthy and results of routine laboratory tests were normal. Oral antibiotic (amoxicillin and clavulanic acid) and topical oxymetazoline hydrochloride 0.005% was prescribed for 10 days. Despite the treatment, patients’ symptoms and endoscopic findings were not improved. A paranasal computed tomographic scan showed a right concha bullosa occluding the nasal passage near totally and left nasal septal deviation (Figure 1). There was no bone erosion and all the paranasal sinuses were well ventilated. She was scheduled for septoplasty and concha bullosa resection under general anesthesia. Following septoplasty the lateral lamella of right middle concha was excised. The conchal cavity was found to be filled with a mass which seems like a fungus ball in appearance (Figure 2). The mass and overlying mucosal layer was removed and sent for pathologic evaluation. The histopathologic examination with H&E staining
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