Paranasal Sinus Wall Erosion and Expansion in Allergic Fungal Rhinosinusitis: An Image Scoring System

Objective (1) To develop an objective method for quantifying radiologic bone erosion in allergic fungal rhinosinusitis (AFRS). (2) To assess the utility of the newly developed AFRS CT staging system in differentiating AFRS patient groups. Methods Patients from two tertiary care rhinology practices with classic AFRS and available CTs (2001–2007) were included for retrospective review. CTs were scored by trained graders not involved in the patients’ care as the primary treating surgeon. The following novel assessment scale was used: Each paranasal sinus wall with expansion/erosion was scored 1 point, with a maximum of 3 points possible for each frontal sinus, 2 points for each ethmoid complex, 3 points for each sphenoid sinus, 3 points for each maxillary sinus, 1 point for the frontal intersinus septum, and 1 point for the sphenoid intersinus septum, yielding a maximum of 24 possible total points. Results 111 CTs were reviewed. Mean score across all patients was 7.8 (range 0–24). Males scored significantly higher than females (mean 9.3 vs 5.6, p < 0.001). African Americans scored significantly higher than Caucasians (mean 9.6 vs 5.0, p < 0.001). There was also a trend towards younger patients exhibiting higher scores (p = 0.07). Conclusions A radiologic grading system for bone erosion/expansion in AFRS is presented, which is easy to apply and may objectively stratify disease severity. Males and African Americans with AFRS demonstrate significantly more bone erosion. Additional analysis of disease course will assess the potential utility of this staging system in predicting outcomes.

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Radiologic staging system for allergic fungal rhinosinusitis (AFRS)

Otolaryngology ◽

10.1016/j.otohns.2008.12.053 ◽

2009 ◽

Vol 140 (5) ◽

pp. 735-740 ◽

Cited By ~ 35

Author(s):

Sarah K. Wise ◽

Gamwell A. Rogers ◽

Mark D. Ghegan ◽

Richard J. Harvey ◽

John M. DelGaudio ◽

...

Keyword(s):

African Americans ◽

Bone Erosion ◽

Tertiary Care ◽

Staging System ◽

Ct Scans ◽

Disease Course ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Sinus Wall ◽

Patient Groups

Objectives: 1) Develop an objective method for quantifying radiologic bone erosion in allergic fungal rhinosinusitis (AFRS); and 2) assess the utility of the new CT scan staging system in differentiating AFRS patient groups. Methods: Patients from two tertiary care rhinology practices with AFRS and available CT scans (1999–2007) were included for review by trained graders. The following novel assessment scale was used: Each paranasal sinus wall with expansion/erosion was scored 1 point, with maximum 3 points possible for each frontal sinus, 2 points for each ethmoid complex, 3 points for each sphenoid sinus, 3 points for each maxillary sinus, and 1 point each for the frontal and sphenoid intersinus septae, yielding maximum of 24 possible points. Results: A total of 111 CT scans were reviewed. Mean score was 7.8 (range, 0–24). Males scored significantly higher than females (mean, 9.3 vs 5.6, P = 0.001). African Americans scored significantly higher than Caucasians (mean, 9.6 vs 5.0, P < 0.001). Conclusions: A scoring system for bone remodeling in AFRS is presented. Males and African-Americans with AFRS demonstrate significantly more bone erosion. Additional analysis of disease course will assess the utility of this staging system in predicting outcomes.

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Evaluation of Diagnostic Criteria for AFRS: A Hospital Based Study

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2017.v25i3.133 ◽

2017 ◽

Vol 25 (3) ◽

pp. 130-135

Author(s):

Krishna V Chaitanya ◽

Lakshmi C Kalavathi

Keyword(s):

Skin Prick Test ◽

Ct Scan ◽

Diagnostic Criteria ◽

Paranasal Sinus ◽

Eosinophil Count ◽

Total Serum ◽

Prick Test ◽

Absolute Eosinophil Count ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis

Introduction Bent and Kuhn criteria are the most commonly accepted diagnostic criteria for diagnosis of Allergic Fungal Rhinosinusitis. Other diagnostic criteria for the diagnosis of Allergic Fungal Rhinosinusitis include unilateral nasal disease, Charcot Leyden crystals, bony erosions which form the minor criteria in the diagnosis of Allergic Fungal Rhinosinusitis. Clinical and Laboratory features in Allergic fungal rhinosinusitis are variable. These variations in the diagnostic criteria in the diagnosis of Allergic Fungal Rhinosinusitis have been analysed in the present study. Materials and Methods Prospective study was performed on group of 46 patients of Allergic fungal Rhinosinusitis presenting in the Otorhinolaryngology OPD with symptoms of Allergic fungal rhinosinusitis as diagnosed and persisting for more than 3 months during September 2009 to August 2010. Results Absolute eosinophil count was elevated in 80.43%, total serum IgE elevated in 69.67%, skin prick test was positive in 63.05% of patients. CT scan revealed that most common paranasal sinus involved is ethmoid sinus as seen in 73.91% cases., Sphenoid sinus was least involved as seen in 17.40% cases. More than one paranasal sinus were involved in 65.21% of the cases.,Complete opacification of all sinuses with calcified deposits were seen in 4.76% cases. Mucosal thickening was seen bilaterally in 73.91% of the patients and bony erosion was noted in 6.52% of patients. Histopathology of nasal smears revealed Eosinophilia in 80.43% of patients. Inflammatory Charcot Leyden crystals were found in 15.21% of the patients45.65% showed goblet cell hyperplasia . Other types of inflammatory cells were seen in 56.52%of the study population and 23.91% patients showed positive fungal hyphae. Discussion The significance of absolute eosinophil count, skin prick test, histopathology, CT Scan features and nasal smear cytology have been discussed along with review of literature. Conclusion Although management of Allergic Fungal Rhinosinusitis has advanced tremendously with better understanding of underlying pathogenesis, diagnostic strategies are still far from clear and are still emerging. Lot of research work has to be carried out regarding relevant diagnostic criteria for the disease.

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NON-INVASIVE FUNGAL RHINOSINUSITIS. ALLERGIC FUNGAL RHINOSINUSITIS

10.33848/foliorl23103825-2019-25-2-59-66 ◽

2019 ◽

Vol 25 (2) ◽

pp. 59-66

Author(s):

L. Gariuc ◽

Keyword(s):

Non Invasive ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis

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Assessment of Maxillary Sinus Wall Thickness with Paranasal Sinus Digital Tomosynthesis and CT

Journal of the Korean Society of Radiology ◽

10.3348/jksr.2017.76.5.314 ◽

2017 ◽

Vol 76 (5) ◽

pp. 314

Author(s):

Jieun Byun ◽

Sung Shine Shim ◽

Yookyung Kim ◽

Kyoung Ae Kong

Keyword(s):

Maxillary Sinus ◽

Paranasal Sinus ◽

Wall Thickness ◽

Digital Tomosynthesis ◽

Sinus Wall

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Allergen Immunotherapy in an HIV+ Patient with Allergic Fungal Rhinosinusitis

Case Reports in Immunology ◽

10.1155/2015/875260 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Ian A. Myles ◽

Satyen Gada

Keyword(s):

Allergen Immunotherapy ◽

Severe Infection ◽

Invasive Fungal Disease ◽

Fungal Disease ◽

Fungal Sinusitis ◽

Opportunistic Pathogens ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Invasive Fungal Rhinosinusitis ◽

Chronic Invasive

Patients with HIV/AIDS can present with multiple types of fungal rhinosinusitis, fungal balls, granulomatous invasive fungal rhinosinusitis, acute or chronic invasive fungal rhinosinusitis, or allergic fungal rhinosinusitis (AFRS). Given the variable spectrum of immune status and susceptibility to severe infection from opportunistic pathogens it is extremely important that clinicians distinguish aggressive fungal invasive fungal disease from the much milder forms such as AFRS. Here we describe a patient with HIV and AFRS to both remind providers of the importance of ruling out invasive fungal disease and outline the other unique features of fungal sinusitis treatment in the HIV-positive population. Additionally we discuss the evidence for and against use of allergen immunotherapy (AIT) for fungal disease in general, as well as the evidence for AIT in the HIV population.

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Sinonasal Surfactant Protein A1, A2, and D Gene Expression in Cystic Fibrosis: A Preliminary Report

Otolaryngology ◽

10.1016/j.otohns.2007.01.025 ◽

2007 ◽

Vol 137 (1) ◽

pp. 34-38 ◽

Cited By ~ 18

Author(s):

Bradford A. Woodworth ◽

Rachel Wood ◽

John E. Baatz ◽

Rodney J. Schlosser

Keyword(s):

Gene Expression ◽

Cystic Fibrosis ◽

Nasal Polyposis ◽

Quantitative Polymerase Chain Reaction ◽

Surfactant Protein ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Novel Treatment ◽

Polymerase Chain

OBJECTIVE: To measure alterations in SPA1, A2, and D gene expression in various forms of inflammatory chronic rhinosinusitis (CRS). STUDY DESIGN AND SETTING: Sinus mucosal biopsies were performed in patients with allergic fungal rhinosinusitis (AFS), CRS with nasal polyposis, cystic fibrosis (CF), and controls. SP mRNA was measured with quantitative polymerase chain reaction. RESULTS: Patients with CF (n = 4) showed significantly increased SPA1 (82-fold), SPA2 (100-fold), and SPD (47-fold) mRNA ( P < 0.05) when compared with controls (n = 5). Patients with CRS with nasal polyposis (n = 5) also demonstrated elevated SPA1 (27-fold), SPA2 (13-fold), and SPD (13-fold). Patients with AFS (n = 7) had increased SPA1 (5-fold), SPA2 (9-fold), and SPD (17-fold), but were not statistically significant. CONCLUSION: SPA1, A2, and D are upregulated in various forms of CRS, but are significantly elevated in cystic fibrosis CRS. SIGNIFICANCE: Understanding the role of SPs in CRS will help develop novel treatment approaches for sinonasal pathoses.

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Allergic fungal rhinosinusitis: an overview on pathogenesis, early diagnosis and management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181853 ◽

2018 ◽

Vol 4 (3) ◽

pp. 694 ◽

Cited By ~ 1

Author(s):

Neeraj Suri ◽

Bhavya B. M.

Keyword(s):

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Histological Evaluation ◽

Nasal Discharge ◽

Fungal Sinusitis ◽

Surgical Specimen ◽

Specimen Handling ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis

Background: The objective of the study was to evaluate the criteria for diagnosing allergic fungal rhinosinusitis and to maintain permanent drainage and ventilation, while preserving the integrity of the mucosa.Methods: This is a prospective study of 50 patients with allergic fungal sinusitis with or without polyposis all of whom were treated with endoscopic debridement. Mucous sample collection, nasal secretion culture, surgical specimen handling, and histological evaluation of surgical specimens are described. All patients treated with endoscopic sinus surgery, debridement, post-operative use of steroids and antifungal therapy. Results: Fungal mucin was found in all 50 cases, histology and fungal cultures confirmed the diagnosis. Out of 50 patients, 29 were females and 21 were males, with a mean age of 32 years. The most common symptom was nasal discharge 41 (82%) cases, nasal obstruction in 38 (76%) cases, headache and facial pain in 32 (72%) cases, 7 (14%) patients had bronchial asthma. Symptoms of nasal obstruction and nasal discharge were improved in 46 (92%) cases. All preoperative versus postoperative changes in AFRS associated complaints reached statistical significance of p value <0.001 except in patients with asthma.Conclusions: Comprehensive management with endoscopic sinus surgery, oral steroids and antifungals reduces the recurrence or need for revision surgery. Long term follow up is very important.

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