Radiographic Nuances in Allergic Fungal Rhinosinusitis

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.

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Prevalence of allergic fungal rhinosinusitis among patients with chronic rhinosinusitis with or without nasal polyposis who underwent endonasal sinus surgery in northwestern Turkey

The Turkish Journal of Ear Nose and Throat ◽

10.5606/kbbihtisas.2014.24382 ◽

2014 ◽

Vol 24 (5) ◽

pp. 259-264 ◽

Cited By ~ 1

Author(s):

Deniz Demir

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyposis ◽

Sinus Surgery ◽

Endonasal Sinus Surgery ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Northwestern Turkey

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Allergic fungal rhinosinusitis with skull base and orbital erosion

The Journal of Laryngology & Otology ◽

10.1017/s0022215109991253 ◽

2009 ◽

Vol 124 (2) ◽

pp. 161-165 ◽

Cited By ~ 16

Author(s):

M S Marfani ◽

M A Jawaid ◽

S M Shaikh ◽

K Thaheem

Keyword(s):

Skull Base ◽

Sinus Surgery ◽

Common Finding ◽

Nasal Discharge ◽

Topical Steroids ◽

Fungal Sinusitis ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Postnasal Drip ◽

Imaging Results

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.

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Distinguishing Molecular Features of Allergic Fungal Rhinosinusitis

Otolaryngology ◽

10.1177/0194599818764349 ◽

2018 ◽

Vol 159 (1) ◽

pp. 185-193 ◽

Cited By ~ 8

Author(s):

Matthew A. Tyler ◽

Caroline J. Padro Dietz ◽

Chris B. Russell ◽

Martin J. Citardi ◽

Shervin Assassi ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Chronic Rhinosinusitis ◽

Quantitative Polymerase Chain Reaction ◽

Sinus Surgery ◽

Type I ◽

Chain Reaction ◽

Molecular Features ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Polymerase Chain

Objective Allergic fungal rhinosinusitis (AFRS) is a clinical subtype of chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by eosinophilic mucin, evidence of fungal elements within the mucin, fungal-specific type I hypersensitivity, and characteristic computed tomography findings. It remains controversial whether AFRS represents a disease with a unique pathophysiology from chronic rhinosinusitis or is merely a severe form of CRSwNP. The goal of this study was to identify molecular features unique to AFRS. Study Design Cross-sectional case-control. Setting Single academic tertiary referral institution. Subjects and Methods Subjects included 86 patients undergoing endoscopic sinus surgery: CRSwNP (n = 34), AFRS (n = 37), and healthy controls (n = 15). Pathway and correlation analyses were performed with whole-genome microarray data for study patients undergoing surgery for recalcitrant chronic rhinosinusitis. Our findings were confirmed with quantitative polymerase chain reaction and immunohistochemical studies. Results AFRS was uniquely characterized by a pronounced association with adaptive T helper 2–associated immune gene expression. AFRS exhibited altered expression of proteins associated with secretory salivary peptides—namely, histatin, a peptide with known antifungal activity in the oral cavity. Furthermore, the expression of histatins correlated negatively with that of type 2 inflammatory mediators. We confirm the decreased expression of histatins in AFRS when compared with CRSwNP by quantitative polymerase chain reaction and localized its expression to a submucosal cell population. Conclusion There exist clear molecular profiles that distinguish AFRS from CRSwNP. This divergence translates into an altered ability to control fungal growth and may in part explain some of the phenotypical differences between CRSwNP and AFRS.

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Systemic corticosteroids for allergic fungal rhinosinusitis and chronic rhinosinusitis with nasal polyposis: A comparative study

Otolaryngology ◽

10.1016/j.otohns.2006.09.010 ◽

2007 ◽

Vol 136 (2) ◽

pp. 252-257 ◽

Cited By ~ 25

Author(s):

Roee Landsberg ◽

Yoram Segev ◽

Ari DeRowe ◽

Tali Landau ◽

Avi Khafif ◽

...

Keyword(s):

Comparative Study ◽

Chronic Rhinosinusitis ◽

Nasal Polyposis ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Systemic Corticosteroids

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Sinonasal Anatomic Variants in Allergic Fungal Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.1177/1945892420978725 ◽

2020 ◽

pp. 194589242097872

Author(s):

Chadi A. Makary ◽

Brock Parman ◽

Brittany Gill ◽

Aykut Unsal ◽

Thomas Holmes ◽

...

Keyword(s):

Retrospective Cohort ◽

Statistical Significance ◽

Concha Bullosa ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Chi Squared ◽

Original Presentation ◽

Unilateral Disease ◽

Anatomic Variants ◽

Unilateral Involvement

Background The pathophysiology of allergic fungal rhinosinusitis (AFRS) is not well understood. Objectives To study the incidence of sinonasal anatomic variants (AVs) in AFRS. Methods Retrospective cohort study. Patients with AFRS presenting to our clinic from 2008 to 2018 were reviewed for laterality of the disease. Patients with unilateral involvement were further studied for AV presence by reviewing their preoperative sinus CT scan at original presentation. Each patient’s uninvolved side served as its own control. AVs studied include agger nasi (AN), Haller’s cells (HC), concha bullosa (CB) and supraorbital ethmoid cells (SOEC). Results A total of 155 patients with AFRS were identified. 30 patients (19.3%) had unilateral disease involvement. Of these, 16 patients had left sided and 14 patients had right sided disease. AV were present in 26 of the 30 AFRS sides (86.7%) and in 21 of the 30 healthy sides (70%), (chi squared = 2.45, p = 0.117). CB were present in 12 of 30 AFRS sides (40%) and only in 1 of 30 healthy sides (3%), (chi squared = 11.88, p = 0.0006). The presence of HC was more common in the AFRS vs healthy sides (7 of 30, 23.3% vs 2 of 30, 6.7%, respectively, p = 0.071). AN and SOEC presence was similar in both AFRS and healthy sides (p = 0.598 and p = 0.718 respectively). Conclusion AV are more common on the sides with AFRS compared to healthy sides, with the presence of CB reaching unquestionable statistical significance. Further study is needed to determine the possible association of AV, especially concha bullosa, with the pathophysiology of AFRS.

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Quality-of-life Outcomes after Sinus Surgery in Allergic Fungal Rhinosinusitis versus Nonfungal Chronic Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2016.30.4280 ◽

2016 ◽

Vol 30 (2) ◽

pp. e30-e35 ◽

Cited By ~ 9

Author(s):

Liam Masterson ◽

Francesco M. Egro ◽

Jessica Bewick ◽

Sally E. Erskine ◽

Alan Clark ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Sinus Surgery ◽

Life Outcomes ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Quality Of Life Outcomes

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Low Incidence of Allergic Fungal Rhinosinusitis in Japanese Patients

Clinical Medicine Insights Ear Nose and Throat ◽

10.1177/1179550619870758 ◽

2019 ◽

Vol 12 ◽

pp. 117955061987075 ◽

Cited By ~ 1

Author(s):

Seiichiro Makihara ◽

Shin Kariya ◽

Tomoyuki Naito ◽

Junya Matsumoto ◽

Mitsuhiro Okano ◽

...

Keyword(s):

Steroid Therapy ◽

Bone Erosion ◽

Sinus Surgery ◽

Postoperative Treatment ◽

High Recurrence Rate ◽

Blood Eosinophil ◽

Peripheral Blood Eosinophil ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Allergic Mucin

Background: Allergic fungal rhinosinusitis (AFRS) is a noninvasive fungal disease of the sinuses with a very high recurrence rate. A very small number of Japanese cases have been reported. Material and methods: The subjects were 6 patients with AFRS out of 429 patients who underwent endoscopic sinus surgery at Kagawa Rosai Hospital between December 2011 and November 2017. We retrospectively examined the clinical features and outcomes of these 6 patients. Results: The incidence of AFRS was 1.4% (6/429). Allergic fungal rhinosinusitis was unilateral in 5 cases and bilateral in 1. Computed tomography revealed hyperdense areas representing allergic mucin, but no patient exhibited bone erosion. Magnetic resonance imaging showed hypointense or no signal regions at the locations of allergic mucin. Postoperatively, 1 patient developed recurrence. Because the recurrent patient had no significant symptoms, he refused further surgery and received drug therapy. Preoperative eosinophil counts and total IgE levels were elevated in all patients; postoperatively, both remained high in the patient who developed recurrence. Postoperative treatments included steroid therapy and nasal irrigation. Conclusions: Allergic fungal rhinosinusitis is less prevalent in Japan than in Western nations. Peripheral blood eosinophil and serum IgE values may be used as the biomarkers. Significance: Allergic fungal rhinosinusitis is prone to recurrence. Postoperative treatment including steroid therapy is important in the management of AFRS.

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Mucosal Eosinophilia and Neutrophilia Are Not Associated With QOL or Olfactory Function in Chronic Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.1177/1945892420987439 ◽

2021 ◽

pp. 194589242098743

Author(s):

Nyssa F. Farrell ◽

Jess C. Mace ◽

David A. Sauer ◽

Andrew J. Thomas ◽

Mathew Geltzeiler ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Nasal Polyposis ◽

Cross Sectional Study ◽

Olfactory Function ◽

Sinus Surgery ◽

Small Subset ◽

Cross Sectional ◽

Snot 22

Background Chronic rhinosinusitis (CRS) is often differentiated by histopathologic phenotypes (eosinophilic versus neutrophilic), which may impact disease severity measures and outcomes. As such, it has been suggested that counts of cellular elements be included as part of a standard pathological report following endoscopic sinus surgery (ESS). Objectives This cross-sectional study evaluated associations of mucosal eosinophilia and neutrophilia with measures of quality-of-life (QoL) and olfactory function. Methods Patients with medically refractory CRS completed the SNOT-22 survey and Brief Smell Identification Test (BSIT) at enrollment. In addition, baseline Lund-Mackay computed tomography (CT) and Lund-Kennedy endoscopy scores were collected. Ethmoid mucosa was biopsied during ESS and reviewed using microscopy to quantify densest infiltrate of eosinophils or neutrophils per high-powered-field (HPF). Eosinophilic CRS (eCRS) and neutrophilic CRS (nCRS), both with and without nasal polyposis (NP), were compared across SNOT-22 and BSIT scores. Results 77/168 patients demonstrated mucosal eosinophilia (eCRS) while a total of 42/168 patients demonstrated mucosal neutrophilia (nCRS). After adjusting for polyp status, 35/168 had eCRSsNP, 42/168 eCRSwNP, 75/168 non-eCRSsNP, 16/168 non-eCRSwNP. Additionally, 22/161 were noted to have nCRSsNP, 20/161 nCRSwNP, 84/161 non-nCRSwNP, and 35/161 non-nCRSsNP. A small subset of patients demonstrated both eosinophilia and neutrophilia: 14 CRSwNP and 7 CRSsNP. When evaluating average Lund-Mackay Scores (LMS), significant differences existed between non-eCRSsNP and eCRSsNP (p = 0.006). However, after controlling for nasal polyps, eosinophilia did not significantly associate with differences in the Lund-Kennedy Score. Neutrophilia did not significantly associate with any changes in LMS or LKS after controlling for NP. Eosinophilic and neutrophilic histopathologic subtypes did not significantly associate with differences in baseline SNOT-22 or BSIT measures after controlling for NP. Conclusion Neither the presence of mucosal eosinophilia nor mucosal neutrophilia demonstrated significant associations with SNOT-22 quality-of-life or BSIT olfactory function scores when controlling for comorbid nasal polyposis.

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