Allergic Fungal Rhinosinusitis
Abstract
Allergic fungal sinusitis is a benign non-invasive sinus disease, believed to be an allergic reaction to aerosolized environmental fungi mainly of demetacious species. It occurs mainly in immunocompetent persons in contrast to other invasive fungal diseases which occur chiefly in immunocompromised patients. It is a cause of recurrent or refractory sinusitis in immunocompetent patients. This entity is probably under diagnosed and should be considered in patients with chronic, intractable sinusitis if there is a history of atopy or asthma. When fungal elements are detected by histopathology or culture from sinus material, AFRS must be differentiated from invasive disease, as treatment and prognosis are radically different.
It is widely accepted that immunological hypersensitivity plays a major role in allergic fungal sinusitis. This has necessitated changes in management methods. There are various options in the treatment of allergic fungal sinusitis. It includes surgical as well as medical modalities. If we look back in surgical treatment for allergic fungal sinusitis, radical surgery has given way to more conservative tissue-sparing approaches. Endoscopic sinus surgery has been shown to be preferable to open sinus techniques. Medical therapy includes corticosteroids, antifungal agents and immunotherapy. For best results, all these modalities should be given in combination.
Follow up is very important postoperatively as allergic fungal sinusitis is known for recurrence. Rate of recurrence is high despite of complete surgery (10-100%). Recurrence can be in the form of mucosal edema, polyps, scarring, allergic mucin, or fungal debris.
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