Allergic fungal rhinosinusitis infiltrating anterior skull base and clivus

AbstractIntroduction:Allergic fungal rhinosinusitis is a benign, noninvasive sinus disease related to hypersensitivity to fungal infection having bony skull base and orbital erosion as common finding.Patients and method:This descriptive study was conducted at the department of otorhinolaryngology, Dow University of Health Sciences, Karachi, Pakistan, from April 2003 to March 2006. In forty-seven proven cases of allergic fungal sinusitis the following information was recorded: demographic data, signs and symptoms, laboratory investigation results, imaging results, pre- and post-operative medical treatment, surgery performed, follow up, and residual or recurrent disease. The Statistical Package for the Social Sciences version 10.0 software was used for data analysis.Results:Findings indicated that allergic fungal rhinosinusitis usually occurred in the second decade of life (51.06 per cent) in males (70.21 per cent), allergic rhinitis (100 per cent) and nasal polyposis (100 per cent). Nasal obstruction (100 per cent), nasal discharge (89.36 per cent), postnasal drip (89.36 per cent), and unilateral nasal and paranasal sinus involvement (59.57 per cent) were significant features. Aspergillus (59.57 per cent) was the most common aetiological agent. Combined orbital and skull base erosion was seen in 30.04 per cent of cases, with male preponderance 6.8:1. Endoscopic sinus surgery was performed in all cases, and recurrent or residual disease was observed in 19.14 per cent.Conclusion:Allergic fungal rhinosinusitis is a disease of young, immunocompetent individual. Skull base and orbital erosion are seen in one-third of cases. Bone erosion is 6.8 times more common in males than females. Orbital erosion is 1.5 times more common than skull base erosion. Endoscopic surgical debridement and drainage combined with topical steroids leads to resolution of disease in the majority of cases, without resorting to systemic antifungal agents, craniotomy or dural resection.

Download Full-text

Post‐operative osteoneogenesis in allergic fungal rhinosinusitis patients with skull base erosions

International Forum of Allergy & Rhinology ◽

10.1002/alr.22949 ◽

2021 ◽

Author(s):

Luke Edelmayer ◽

Aditya K. Devarakonda ◽

Jeffrey J. Falco ◽

Thomas Holmes ◽

Stilianos Kountakis ◽

...

Keyword(s):

Skull Base ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis

Download Full-text

Socioeconomic Factors in Allergic Fungal Rhinosinusitis with Bone Erosion

American Journal of Rhinology ◽

10.2500/ajr.2007.21.3082 ◽

2007 ◽

Vol 21 (5) ◽

pp. 560-563 ◽

Cited By ~ 20

Author(s):

Mark D. Ghegan ◽

Sarah K. Wise ◽

Edward Gorham ◽

Rodney J. Schlosser

Keyword(s):

African Americans ◽

Socioeconomic Factors ◽

Skull Base ◽

Bone Erosion ◽

Demographic Data ◽

Tertiary Care ◽

Poverty Level ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Socioeconomic And Demographic Factors

Background Previous studies have shown an increase in the incidence of orbital and skull base erosion in African Americans and males diagnosed with allergic fungal rhinosinusitis (AFRS). However, underlying reasons for the advanced presentation of AFRS in certain ethnic and gender groups are currently unknown. We evaluated several socioeconomic and demographic factors for their possible contribution to advanced presentation of AFRS in our patient population. Such factors have not been examined previously in the literature. The aim of this study was to evaluate the contribution of race, ethnicity, and various socioeconomic factors to the advanced presentation of AFRS with orbital and skull base bone erosion. Methods Retrospective review of medical records and radiological studies were performed for 54 consecutive AFRS patients presenting to a tertiary care rhinology practice. Presence of radiological evidence of bone erosion was compared with demographic data and insurance status, as indicated in the medical record. Bone erosion status was evaluated also against state demographic data, divided by county. Results Males were significantly more likely to present with bone erosion than females (p = 0.009). In this analysis, age and race were not statistically associated with the presence of bone erosion. Additionally, no statistically significant correlations were identified between bone erosion and several socioeconomic factors listed from the patient's county of residence (percentage below the poverty level, median household income, population percentage of African Americans, or number of physicians per 1000 residents). Conclusion No socioeconomic factors were identified that correlated with the incidence of bone erosion in patients diagnosed with AFRS. Factors other than socioeconomic status and access to health care appear to play a role in the advanced presentation of AFRS.

Download Full-text

Extensive Allergic Fungal Rhinosinusitis: Ophthalmic and Skull Base Complications

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-014-0771-x ◽

2014 ◽

Vol 67 (3) ◽

pp. 227-233 ◽

Cited By ~ 4

Author(s):

Ashish Vashishth

Keyword(s):

Skull Base ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis

Download Full-text

Incidence of Skull Base and Orbital Erosion in Allergic Fungal Rhinosinusitis (AFRS) and Non-AFRS

Otolaryngology ◽

10.1016/j.otohns.2005.11.025 ◽

2006 ◽

Vol 134 (4) ◽

pp. 592-595 ◽

Cited By ~ 47

Author(s):

Mark D. Ghegan ◽

Fu-Shing Lee ◽

Rodney J. Schlosser

Keyword(s):

Skull Base ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis

Download Full-text

Radiographic Nuances in Allergic Fungal Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.1177/1945892419825695 ◽

2019 ◽

Vol 33 (3) ◽

pp. 310-316 ◽

Cited By ~ 6

Author(s):

Nicholas R. Rowan ◽

Tyler A. Janz ◽

Rodney J. Schlosser ◽

Zachary M. Soler

Keyword(s):

Skull Base ◽

Chronic Rhinosinusitis ◽

Nasal Polyposis ◽

Residual Disease ◽

Sinus Surgery ◽

Concha Bullosa ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Unilateral Disease ◽

Allergic Mucin

Background Allergic fungal rhinosinusitis (AFRS) is characterized by higher revision endoscopic sinus surgery (ESS) rates and unique radiographic features when compared to chronic rhinosinusitis with nasal polyposis (CRSwNP) or chronic rhinosinusitis without nasal polyposis (CRSsNP). Objective We hypothesized that an increased frequency of concha bullosa in AFRS or other radiographic nuances might allow for accumulation of allergic mucin and contribute to increased ESS revision rates. Methods A retrospective cohort study was performed. Patient diagnosis (AFRS, CRSwNP, and CRSsNP), basic demographics, and prior ESS rates were collected. Results A total of 210 consecutive patients were included (AFRS = 70, CRSwNP = 70, and CRSsNP = 70). Pediatric AFRS patients had more unilateral disease (38.1% vs 4.4%; P = .007) and anterior ethmoid skull base erosion (23.8% vs 6.7%; P = .047) than adult AFRS patients. AFRS patients were more likely to be younger (24.9 ± 10.1 years vs 45.6 ± 14.4 years vs 48.7 ± 18.2 years; P < .001), African American (70% vs 14.3% vs 11.4%; P < .001), and have undergone prior ESS (54.3% vs 45.7% vs 31.4%; P = .02) than CRSwNP or CRSsNP patients. Concha bullosa were more prevalent in AFRS patients than CRSwNP or CRSsNP patients across the population (42.9%, 18.6%, and 14.3%; P < .001) and in the setting of no previous surgery (53.1%, 31.6%, and 16.7%; P < .001). Conclusion In this cohort, pediatric AFRS patients had more unilateral disease and anterior ethmoid skull base erosion. Concha bullosa prevalence was significantly higher in AFRS as compared to those with CRSwNP or CRSsNP, despite prior ESS. Surgeons should consider concha bullosa as a potential anatomical subsite to harbor recurrent or residual disease.

Download Full-text