Evaluation of Diagnostic Criteria for AFRS: A Hospital Based Study

Abstract

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.