To analyze the epidemiological characteristics, clinical features, and the outcomes of histopathology and microbiology for fungus ball (FB) in the last 10 years in our department.Database review.In total, 1,717 cases of FB were reviewed from the case database of Beijing Tongren Hospital (between 2008 and 2017). Epidemiologic data, clinical manifestations, histopathology, and microbiology were analyzed.In the past 10 years, there has been a significant increase in patients with FB presenting at our department (P < .05). The mean age of patients with paranasal sinus FB was 54 years, and 67% of patients were female (1,156/1,717). The average age and female predominance were consistent with previous reports. In total, 1,626 cases (94.7%) were unilateral, and the most common location was the maxillary sinus (76.6%). Aspergillus spp. (72.8%) was the most abundant fungal species in our study. The direct smear positive rate was 68.6%, and the fungal culture rate was 22.6%. All cases were treated with functional endoscopic sinus surgery, with a very low rate of postoperative complications and reoperation (20/1,717).Histopathological and microbiological analyses are essential for the diagnosis of FB. Surgery is the most effective method of treatment. Direct smear after surgery is not necessary. Oral or topical antimycotic treatments are not recommended after surgery or during the perioperative period.4 Laryngoscope, 2019.