Allergic Fungal Sinusitis: A Review with Four Illustrated Cases

1994 ◽  
Vol 8 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Marc F. Goldstein ◽  
Eliot H. Dunsky ◽  
Donald J. Dvorin ◽  
Raymond W. Lesser
Keyword(s):  
Case Reports ◽  
Surgical Care ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Nasal Airway ◽  
Allergic Fungal Sinusitis ◽  
Intranasal Steroids ◽  
Oral Corticosteroids ◽  
Allergic Mucin ◽  
Histopathologic Findings

Although paranasal fungal sinusitis is rare, an increased number of Aspergillus and non-Aspergillus related cases of allergic fungal sinusitis have been described since its first report in 1983. The histopathologic findings necessary for a definitive diagnosis rest upon the detection of scattered fungal elements in a matrix of allergic mucin. The clinical spectrum and treatment of allergic fungal sinusitis are detailed within four illustrated case reports. Sinus surgery, followed by meticulous post-surgical care by an allergy and otolaryngology team using oral corticosteroids, and followed by maintenance intranasal steroids and nasal airway irrigations in conjunction with allergy immunotherapy, has resulted in excellent clinical outcomes.

Allergic Fungal Sinusitis Associated with Allergic Bronchopulmonary Aspergillosis: An Uncommon Sinobronchial Allergic Mycosis

2007 ◽  
Vol 21 (4) ◽  
pp. 412-416 ◽  
Author(s):  
Jean Jacques Braun ◽  
Gabrielle Pauli ◽  
Philippe Schultz ◽  
André Gentine ◽  
David Ebbo ◽  
...  
Keyword(s):  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Antifungal Drugs ◽  
Sinus Surgery ◽  
Skin Tests ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Positive Skin ◽  
Oral Corticosteroids ◽  
Blood Eosinophils

Background The identification of allergic fungal sinusitis (AFS) is still controversial and much more recent than that of allergic bronchopulmonary aspergillosis (ABPA). Their association has been reported very rarely in the literature. Methods The aim of this study was to present a review of 6 cases of AFS associated with ABPA from a series of 12 cases of AFS and to compare AFS associated with ABPA and isolated AFS. Results All cases of AFS presented with chronic rhinosinusitis. The six cases with AFS and ABPA were atopic, asthmatic, with pulmonary infiltrates (five cases), central bronchiectasis (four cases), and both (three cases). The mycological and immunoallergological features of isolated AFS and AFS associated with ABPA were similar: eosinophilic allergic mucin with noninvasive fungi hyphae, high levels of blood eosinophils, total IgE, specific IgE, IgG, and positive skin tests to Aspergillus. The association of AFS and ABPA was concomitant (two cases) or remote in time (four cases). The treatment with oral corticosteroids and sinus surgery (six cases) associated with antifungal drugs (four cases) led to resolution in three cases, considerable improvement in one case, and therapeutic failure in two cases (follow-up longer than 5 years in all cases). Conclusion Independently of the signs linked to the organs involved (sinuses and bronchi) the mycological and immunoallergological features were similar for AFS and AFS associated with ABPA. AFS and ABPA can be isolated or associated in a sinobronchial allergic mycosis.

Treatment of Allergic Fungal Sinusitis with High-Dose Itraconazole

2003 ◽  
Vol 17 (1) ◽  
pp. 1-8 ◽  
Author(s):  
B. Manrin Rains ◽  
Corey W. Mineck
Keyword(s):  
Low Dose ◽  
Treatment Protocol ◽  
Sinus Surgery ◽  
High Dose ◽  
Fungal Culture ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Radiographic Findings ◽  
Topical Corticosteroids ◽  
Oral Corticosteroids

Background Since its original description in the early 1980s, our understanding of allergic fungal sinusitis (AFS) has continued to evolve. The goal of this research was to characterize the typical AFS patient and describe a treatment protocol using endoscopic sinus surgery, high-dose itraconazole, low-dose bursts of oral corticosteroids, and topical corticosteroids. Methods A 12-year retrospective chart review was conducted to extract demographic and management data on 139 patients meeting the AFS criteria of atopy, characteristic radiographic findings, eosinophilic mucin, nasal polyposis, and a positive fungal culture or stain. Results The typical AFS patient presented at 42.8 years of age, was female, and had 3.5 positive fungal cultures over an average of 31.4 months of follow-up. Although 69 patients (50.3%) experienced recurrence, reoperation was required in only 17 (20.5%) of 83 patients initially managed by our protocol. There were no serious adverse effects attributed to itraconazole over the 36,000 doses prescribed. Conclusion The use of itraconazole, short-burst low-dose oral corticosteroids, topical corticosteroids, and endoscopic surgery is a safe and clinically effective regimen in the management of AFS. Our clinical experience suggests medical management of recurrent AFS with itraconazole may avoid revision surgery.

Response of Visual Loss in Allergic Fungal Sinusitis to Oral Corticosteroids

2005 ◽  
Vol 114 (3) ◽  
pp. 247-249 ◽  
Author(s):  
Scott M. Graham ◽  
Keith D. Carter
Keyword(s):  
Visual Loss ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Medical Comorbidities ◽  
Oral Corticosteroids

Visual loss associated with allergic fungal sinusitis is most often treated with surgery followed by oral corticosteroids. A case is presented in which, because of substantial medical comorbidities, surgery could not be initially performed and the visual loss was corrected with prednisone alone. This case serves to reinforce the central role of corticosteroids in treatment of this enigmatic condition.

scholarly journals Study to Determine the Incidence of Allergic Fungal Sinusitis among Patients with Nasal Polyps and Its Related Risk Factors

2021 ◽  
Vol 15 (7) ◽  
pp. 1860-1863
Author(s):  
Bakht Zada ◽  
Ejaz Ahmed ◽  
Muhammad Habib ◽  
Zafar Iqbal ◽  
Rehan Saleem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nasal Septum ◽  
Nasal Polyps ◽  
Bone Erosion ◽  
Histopathological Examination ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Deviated Nasal Septum ◽  
Allergic Fungal Sinusitis ◽  
Turbinate Hypertrophy

Aim: To govern the incidence of allergic fungal sinusitis in patients with nasal polyposis. Various anatomical risk factors were also investigated, including turbinate hypertrophy, deviated nasal septum and comorbidities such as asthma and diabetes. Study Design: This is a Descriptive cross-sectional study. Place and duration of study:The study was conducted at ENT Head &Neck Surgery department, Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for the duration of six months from May 2020 to October 2020. Methods: 110 patients with nasal polyps were evaluated and operated on. Samples were sent for histopathological examination and culture. All patients were assessed with clinical examination and detailed history. Laboratory tests were performed including complete blood counts, urea, electrolytes, ECG and chest radiographs for the suitability of general anesthesia as a prerequisite for surgery. In 95% of cases, computed tomography was recommended to check for sinus involvement, bone erosion, osteo-hypertrophic complex, turbinate hypertrophy, nasal septal deviation, and intracranial and intra-orbital enlargement. MRI examinations were also recommended in cases of suspected intraocular and intracranial disease (5%). Data was scrutinized on a computer using SPSS version 22.0. Results:Of the 110 patients, 65 were male and 45 were female, with a mean age of 1and ranged from 7 to 80 years. All patients had nasal polyps. The incidence of AFS was approximately 29.1% and the remaining 78 had a different pathology. Major deviation of the nasal septum and bilateral hypertrophy of the inferior turbinate’s were observed in 6 (18.7%) and 4 (12.5%) patients, respectively. Unilateral nasal polyps were observed in 7 (21.9%) patients and bilateral nasal polyps in 18 (52.3%). 19/32 (59.4%) of the cases underwent functional endoscopic surgery of the paranasal sinuses, and in 6 (18.7%) external fronto-ethmoidectomy. Two patients underwent nasal ethmoidectomy. Septoplasty and endoscopic sinus surgery were performed in a total of 3 (9.37%) cases. Key words:Allergic bronchopulmonary aspergillosis (ABPA), Allergic fungal sinusitis (AFS).

Allergic Mucin With and Without Fungus

2001 ◽  
Vol 125 (11) ◽  
pp. 1442-1447
Author(s):  
Jonathan F. Lara ◽  
J. Daniel Gomez
Keyword(s):  
Tertiary Care ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Radiographic Findings ◽  
Care Institution ◽  
Tertiary Care Institution ◽  
Allergic Mucin ◽  
And Gender

Abstract Context.—Allergic mucin, a lamellated collection of inspissated inflammatory debris, has been a hallmark of allergic fungal sinusitis. While its identification is a clue for pathologists to search for fungi, and directs clinicians toward specific therapy and follow-up, recent reports describe cases with allergic mucin but without concomitant fungus. The absence of such organisms in otherwise typical allergic mucin brings into question the role of fungi in allergic fungal sinusitis. Objectives.—To study clinical and pathologic differences between patients with allergic mucin in surgical nasal resection specimens and to elucidate the role of fungus in allergic sinusitis. Design.—Patients with histologic evidence of allergic mucin, with and without fungus, were identified and retrieved from the surgical pathology files of a tertiary-care institution. The patients were separated into 2 groups for analysis, and their clinical and pathologic findings were reviewed and compared. Setting.—Tertiary-care institution. Patients.—All patients who underwent sinus mucosal resection between 1992 and 1998. Results.—Clinical presentation and radiographic findings were similar in both groups. Incidence, age, and gender distribution were similar to data reported previously. However, the amount of allergic mucin was much greater in the group with fungus than in the group without fungus, which to our knowledge is an unreported observation to date. Conclusion.—The presence of allergic mucin is not unique to allergic fungal sinusitis, but rather is the result of a process that could have other etiologies. While perhaps not always causative to the disease, the fungus continues to fuel the process and is likely an entrapped bystander. Allergic fungal sinusitis is more appropriately termed allergic mucinous sinusitis or eosinophilic mucinous rhinosinusitis.

The Effect of the Total Intravenous Anesthesia Compared with Inhalational Anesthesia on the Surgical Field during Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (5) ◽  
pp. 514-520 ◽  
Author(s):  
Peter J. Wormald ◽  
Graham van Renen ◽  
Jonathon Perks ◽  
Janine A. Jones ◽  
Claire D. Langton-Hewer
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Total Intravenous Anesthesia ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Allergic Fungal Sinusitis ◽  
Surgical Field

Background Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed. Methods Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses offentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system. Results The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001). Conclusion In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.

Current Indications for Pediatric Endoscopic Sinus Surgery

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P63-P63
Author(s):  
Rahul K Shah ◽  
George H Zalzal ◽  
Maria T Pena
Keyword(s):  
Cystic Fibrosis ◽  
Blood Clot ◽  
Tertiary Care ◽  
Care Facility ◽  
Acute Sinusitis ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Intracranial Complication ◽  
Tertiary Care Facility

Objective To describe current indications, sinonasal pathologies, and outcomes of endoscopic sinus surgeries (ESS) in children. Methods Retrospective chart review of children that underwent ESS at a children's tertiary care facility from July 2004 to June 2007 was performed. Demographic data, clinical profiles, surgical procedures including revisions, and complications were analyzed. Results 117 ESS were performed on 88 children (mean age 9.6 years) and 4 adults; 64 were male. The most common indications for ESS in descending order were: chronic rhino-sinusitis (CRS) (n=29), subperiosteal periorbital abscess (n= 20), sinonasal neoplasm (n= 11), intracranial complication from acute sinusitis (n=8), CRS with cystic fibrosis (n=8), complicated acute sinusitis (n=6), allergic fungal sinusitis (n=5), antrochonal polyps (n=2), invasive fungal sinusitis (n=1), and other pathologies (n=2). 21 children underwent an average of 2.2 sinus procedures. Majority of revisions were on patients with tumors (46%), allergic fungal sinusitis (40%), intracranial complication from acute sinusitis (38%), complicated acute sinusitis (33%), subperiosteal periorbital abscess (15%), CRS with cystic fibrosis (13%), and CRS (10%). Two children had excessive bleeding requiring another anesthetic to complete the procedure; 1 patient had airway obstruction from a tracheal blood clot requiring bronchoscopy. Conclusions More than 2/3rds of patients had ESS for indications other than uncomplicated CRS. Approximately 1/4 required revision surgeries reflecting the complexity of sinonasal pathologies seen in children compared with adults. Otolaryngologists performing pediatric ESS must not only be skilled in sound surgical technique, but must have appropriate interdisciplinary professional support to address the associated clinical problems seen in children.

Schizophyllum commune Sinusitis: A Case Report and Radiologic Findings

1995 ◽  
Vol 9 (3) ◽  
pp. 149-154 ◽  
Author(s):  
Brian E. Emery ◽  
Arnold D. Oberle ◽  
Fleurette Abreo ◽  
Terry A. Day ◽  
Fred J. Stucker
Keyword(s):  
Chronic Sinusitis ◽  
Schizophyllum Commune ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Mri Findings ◽  
Allergic Fungal Sinusitis ◽  
Common Chronic Disease ◽  
Radiologic Findings ◽  
Magnetic Resonance Imaging Mri ◽  
First Time

Chronic sinusitis is now considered the most common chronic disease seen in this country.1 The infections are commonly polymicrobial and include aerobes and anaerobes.2 Fungal sinusitis accounts for up to 10% of cases of chronic sinusitis, and the disease ranges from allergic fungal sinusitis through fungus balls to invasive fungal sinus disease.3,4 We report the case of a 19-year-old black female with nasal obstruction, clear rhinorrhea, and nasal polyps. She underwent endoscopic sinus surgery after medical management failed to eradicate her symptoms. Cultures from her paranasal sinuses grew S. commune, a mushroom, a member of the Basidiomycetes. There have been four prior reports of S. commune sinusitis described in the literature. Presented is a review of the literature, a description of the histologic, mycologic, and radiologic findings and suggested treatment. The magnetic resonance imaging (MRI) findings are presented here for the first time.

Efficacy of Post-Operative Oral Prednisolone for the Control of Disease in Allergic Fungal Sinusitis

2021 ◽  
pp. 13-17
Keyword(s):  
Study Groups ◽  
Sinus Surgery ◽  
Oral Steroid ◽  
P Value ◽  
Complete Relief ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Oral Steroids ◽  
Group A ◽  
Group B

Background: Ambiguity persists regarding the dosage, frequency, and duration for the use of oral steroids in Allergic Fungal Sinusitis (AFS). Objective: To assess the efficacy of post-operative oral steroid (prednisolone) for the control of disease in Allergic Fungal Sinusitis. Methodology: This was a comparative study, conducted at Bahawal Victoria Hospital, Bahawalpur from January 2019 to March 2019. A total of 40 patients, aged 18 or above with weight over 50 kilograms, having proved Allergic Fungal Sinusitis (AFS) as per criteria defined by Deshazo and Swain, were recruited for this study. All the patients were enrolled within 14 days of excisive sinus surgery adopting endoscopic sinus surgery with or without open methods. Group A (n=20) received oral steroids while Group B (n=20) received a placebo. Patients of both groups also used fluticasone nasal spray and oral itraconazole. Evaluation of all the patients was done at the time of enrollment, 6 and 12 weeks. Data were analyzed by SPSS version 21. Results: Out of a total of 40 patients, 17 (42.5%) were males. After 6 weeks of continuous therapy in both the study groups, 14 (70%) patients of Group A showed complete relief of symptoms in comparison to none in Group B (p-value = 0.001). After 12 weeks of therapy having tapering off in both study groups, all patients in Group A had complete relief of symptoms in comparison to only one (5%) in Group B (p-value = 0.001). Conclusion: Oral steroids of prednisolone, along with inhaled steroids therapy for a minimum of 12 weeks after excisive sinus surgery were found efficacious for the control of disease in patients with Allergic Fungal Sinusitis.

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