Skip to main content
PMC home page
Indian Journal of Otolaryngology and Head & Neck Surgery logoLink to Indian Journal of Otolaryngology and Head & Neck Surgery
. 2007 Apr 26;59(1):35–40. doi: 10.1007/s12070-007-0009-2

Management protocols of Allergic Fungal Sinusitis

Rishi Pal Gupta 1,✉, Sudhir Bahadur 1, Alok Thakar 1, K K Handa 1, Chitra Sarkaar 2
PMCID: PMC3451720  PMID: 23120381

Abstract

Controversy surrounds the appropriate surgical approach and the appropriate medical therapy for Allergic Fungal Sinusitis. The present prospective study aims to assess the impact of these factors on the treatment outcome of Allergic Fungal Sinusitis. In the present study 34 cases with AFS were randomized into one of 3 methods of post operative therapy i.e. systemic itraconazole (group A, n=11), topical steroids (group B, n=12) and nasal alkaline douches only (group C, n=11). Outcome was assessed at 6 months post-operative by the Kupferberg grading system for assessment of nasal and sinus mucosa. Grade ‘3’ mucosal disease was defined as recurrence.

Complete pre-operative opacification of sphenoid and frontal sinus was a predictor of poorer outcome. Postoperative systemic itraconazole therapy demonstrated a trend towards a better outcome but was not statistically significant. Larger trials are required to conclusively evaluate the merit of various post-operative treatment regimens for AFS.

Keywords: Aspergillosis, paranasal sinus, itraconazole, endoscopic sinus surgery

Full Text

The Full Text of this article is available as a PDF (251.7 KB).

References

  • 1.Perez-Jaffe L.A., Lanza D.C., Loevner L.A., Kennedy D.W., Montone K.T. Instituhybridization for aspergillus and penicillin in allergic fungal sinusitis: A rapid means of speciating fungal pathogens in tissues. Laryngoscope. 1997;107:233–240. doi: 10.1097/00005537-199702000-00017. [DOI] [PubMed] [Google Scholar]
  • 2.Quraishi J.A., Ramadan H.H. Endoscopic treatment of allergic fungal sinusitis Otolaryngology — Head and Neck Surgery. 1997;117(1):29–34. doi: 10.1016/S0194-59989770202-X. [DOI] [PubMed] [Google Scholar]
  • 3.Bent J.P., Kuhn F.A. Diagnosis of AFS. Otolaryngology. Head and Neck Surgery. 1994;111:580–587. doi: 10.1016/S0194-5998(94)70525-9. [DOI] [PubMed] [Google Scholar]
  • 4.Manning S.C., Mabry P., Schafer S.D., Close L.G. Evidence of IgE mediated hypertensitivity in allergic fungal sinusitis. Laryngoscope. 1993;103:717–721. doi: 10.1288/00005537-199307000-00002. [DOI] [PubMed] [Google Scholar]
  • 5.Kartzenstein A.L., Sale S.R., Greenberger P.A. Allergic aspergillus sinusitis: A newly recognized form of sinusitis. Journal of Allergy and Clinical Immunology. 1983;72(1):89–93. doi: 10.1016/0091-6749(83)90057-X. [DOI] [PubMed] [Google Scholar]
  • 6.Waxman J.E., Spector J.G., Sale S.R. Allergic aspergillus sinusitis: concepts in diagnosis and treatment of a new clinical entity. Laryngoscope. 1987;97:261–266. doi: 10.1288/00005537-198703000-00001. [DOI] [PubMed] [Google Scholar]
  • 7.Manning S.C., Merkel M., Kriesel K., et al. Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis. Am J Rhinol. 1998;12:263–268. doi: 10.1097/00005537-199702000-00007. [DOI] [PubMed] [Google Scholar]
  • 8.Cody D.T., Neel H.B., Ferreiro J.A., Roberts G.D. Allergic fungal sinusitis. The Mayo Clinic experience. Laryngoscope. 1994;104:1074–1079. doi: 10.1288/00005537-199409000-00005. [DOI] [PubMed] [Google Scholar]
  • 9.Allphin A., Strauss M., Abdul Karim F.W. Allergic fungal sinusitis: Problems in diagnosis and treatment. Larynogoscope. 1991;101:815–820. doi: 10.1288/00005537-199108000-00003. [DOI] [PubMed] [Google Scholar]
  • 10.Marple B.F., Mabry R.I. Comprehensive management of allergic fungal sinusitis. Am J Rhinol. 1998;12:263–268. doi: 10.2500/105065898781390037. [DOI] [PubMed] [Google Scholar]
  • 11.Kupferberg S.B., Bent J.P., Kuhn F.A. Prognosis for allergic fungal sinusitis Otolaryngology — Head and Neck Surgery. 1997;117(1):35–41. doi: 10.1016/S0194-5998(97)70203-1. [DOI] [PubMed] [Google Scholar]
  • 12.Schwartz H.J. AFS. Experience in an ambulatory allergy practice. Annals of Allergy, Asthma and Immunology. 1996;77:500–502. doi: 10.1016/S1081-1206(10)63359-5. [DOI] [PubMed] [Google Scholar]
  • 13.Fryen/ Mayser — AFS by Bipolaris Hawaiensis. Eur Arch of ORL 1999; 256(7): 330–4. [DOI] [PubMed]
  • 14.Swift D. Skull base ostitis following fungal sinusis: The Journal of Laryngology and Otology. 1998;112:92–97. doi: 10.1017/s0022215100140009. [DOI] [PubMed] [Google Scholar]
  • 15.Kupferberg S.B., Bent J.P. Allergic fungal sinusitis in the pediatric population. Archives of Otolaryngology and Head Neck Surgery. 1996;122:1381–1384. doi: 10.1001/archotol.1996.01890240087019. [DOI] [PubMed] [Google Scholar]
  • 16.Dhiwaker M., Thakar A., Bahadur S., Sarkar C., et al. Preoperative Diagnosis of Allergic Fungal Sinusitis: The Laryngoscope. 2003;113(4):688–694. doi: 10.1097/00005537-200304000-00020. [DOI] [PubMed] [Google Scholar]
  • 17.Lund VJ, Kennedy DW. Quantification for staging sinusitis. Annals of Otology, Rhinology and Laryngology. 1995, pg. 17–21. [PubMed]

Articles from Indian Journal of Otolaryngology and Head & Neck Surgery are provided here courtesy of Springer

RESOURCES