Introduction Fungal ball (FB) is a non-invasive fungal rhinosinusitis characterised by dense hyphal aggregates within the paranasal sinuses, most commonly the maxillary sinus. Although usually affecting immunocompetent patients, recurrence can occur and prognostic factors remain uncertain. Australian data are limited despite a growing incidence worldwide. Setting: Tertiary Australian subspecialty hospital over a five-year period (2018–2023). Ethics was obtained prospectively. Methods: Retrospective cohort review of adults undergoing functional endoscopic sinus surgery (FESS) for confirmed fungal ball. Demographic, clinical, radiological, microbiological, and surgical data were collected. The primary outcome was recurrence requiring revision surgery. Results: Of 171 patients screened, 46 patients were included for analysis. Mean age was 58.7 years, and most were female (69.6%). Most patients presented with symptomatic (92.7%) at time of presentation, with maxillary sinus fungal call (91.7%). Aspergillus was the most frequent pathogen. Four patients with maxillary sinus fungal ball required revision surgery, and no patients with sphenoid sinus fungal ball required revision. Recurrence was more common in patients with diabetes, facial pain, or alcohol use. Postoperative budesonide rinses were also associated with recurrence. No patients required more than two operations, and no cerebrospinal fluid leaks, orbital complications, or deaths were observed. Conclusions Fungal ball treated with sinus surgery has a low recurrence rate. Patients with maxillary sinus fungal ball, diabetes, or requiring postoperative steroids may warrant closer follow-up. Routine follow-up to three months postoperatively is recommended.