Diagnostic certainty and outcome reporting in sinus fungus balls with African clinical examples

Background: Paranasal sinus fungus balls must be distinguished from allergic and invasive fungal rhinosinusitis. Small clinical reports can clarify diagnosis and treatment, but their interpretation depends on pathological confirmation, anatomical location and follow-up. This review examines these issues using selected African publications within the broader clinical literature. Main body: Targeted searches of indexed records and publisher websites were completed on 29 September 2026. A critical narrative synthesis considered definitions, diagnostic certainty, operative management and outcome reporting. Selected Tunisian reports described surgically treated lesions, including isolated frontal disease; a Moroccan concha bullosa report represented a different anatomical site and a presumptive diagnosis. In a mixed Tunisian noninvasive cohort, fungus-ball labels could not be equated with uniformly documented histological confirmation. CT findings supported suspicion, while pathology and assessment of tissue invasion determined classification. Fungal culture contributed organism information but could not reliably exclude a fungus ball when negative. International surgical evidence supported effective clearance in selected patients, without establishing an Africa-specific success rate. The review proposes explicit reporting of diagnostic evidence, anatomical access, mucosal assessment and time-specific outcomes. Short conclusion: Interpretation of fungus-ball reports requires separating imaging suspicion, documented fungal material and exclusion of invasion. Regional case reports should not be pooled uncritically with mixed fungal cohorts or used to infer continental prevalence. Standardised reporting would improve both clinical communication and the value of future multicentre research.