Invasive fungal sinusitis is a highly morbid disease and a true otolaryngologic emergency. In this presentation, we will review the current data regarding the diagnosis (and challenges of diagnosis), treatment options, and outcomes for both acute and chronic invasive fungal sinusitis. We will examine symptomatology, pathology, and CT and MRI findings, the latter which can oftentimes guide surgical planning very precisely. We will cover indications for transfer to a tertiary medical center, and options for long term follow-up of these at-risk patients. Lastly, we will discuss future research needs to improve our understanding of this disease process and help guide patient management/improve patient outcomes. Every otolaryngologist will encounter this disease process in their careers at some point, and early diagnosis plus a basic understanding of treatment options are absolutely vital to ensure best possible patient outcomes.