Management Of Allergic Fungal Sinusitis Research Articles

Diagnosis and management of allergic fungal sinusitis

Background: Fungal Rhinosinusitis is one of the common diseases affecting the Nose and Paranasal Sinuses. Various fungi cause the disease. These infections are termed as invasive Fungal Infections, when they occur in immunologically compromised individuals, and Diabetics. Objective: To evaluate the use of diagnostic criteria to confirm the fungal rhinosinusitis disease with radiological, pathological and microbiological investigations and their management. Materials and Methods: A prospective observation study has been conducted at, in which 21 patients presenting to the Ear, Nose and Throat (ENT) department of our institution with clinical features of fungal sinusitis. After thorough clinical examination, the patients underwent investigations including hematological tests, radiological tests, diagnostic nasal endoscopy, histopathological examination and microbiological examination. Clinical examination including complete ENT & Head and Neck examination and cranial nerves examination was done to all the 21 patients included in the study. The data collected was imported into excel sheet (Microsoft Excel) for further evaluation in obtaining the results. The frequencies of distribution of various variables of the study were represented in the form of tables. Results: 19 patients presented with nasal obstruction, 18 with nasal discharge, 14 with sneezing, 8 with headache, 11 with anosmia, 8 with nasal allergy, 9 with asthma, 7 with Diabetes mellitus, and 7 with previous history of nasal surgery. On clinical examination, polyps were found in 16 patients. Conclusion: Post-operative use of Systemic and Local Steroids, Antihistamines, Decongestants, Regular nasal douching and Anti-fungal antibiotics wherever necessary, helps in early healing of the cavities and also reduces recurrence. Postoperative regular follow up for endoscopic suction clearance of the debris, crusts, and removal of granulation tissue, helps in identifying early recurrence and gives the surgeon to plan further treatment.

Efficacy of Different Modalities of Treatment in Management of Different Types of Fungal Sinusits

Abstract Background Fungal sinusitis is generally classified into invasive and non invasive fungal sinusitis based on histological features, invasive fungal sinusitis divided into acute, chronic and chronic granulomatous invasive fungal sinusitis. While non invasive fungal sinusitis include saprophytic fungal infestation, fungal ball, and fungus-related eosinophilic. Distinguishing invasive disease from noninvasive disease is important because the treatment and prognosis are different for each. AIM A systemic review of effective and safe method in management of different types of fungal sinusitis either by medical or surgical approaches or even combined. Be up to date with the different upcoming new modalities. Methodology A meta-analysis study is done to evaluate the medical and surgical outcomes of patients with invasive and noninvasive Fungal Sinusits. Results Finally, forty-five studies were included in the present systematic review and metaanalysis. Fifteen included studies (No = 539 patients) assessed different modalities for management of fungal ball, via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach for FB of the maxillary sinus. The results showed that functional endoscopic sinus surgery has led to success rate of 98.1%. Twenty included studies (No = 806 patients) have assessed the efficacy and safety of different modalities for the management of allergic fungal sinusitis via,Endoscopic Sinus Surgery, Post-ESS Systemic steroids, Antifungals and immunotherapy. The results showed that ESS represents the firstline management strategy of AFRS, followed by aggressive medical therapies, the recurrence rate after postoperative steroids was 20.6%, postoperative antifungals was 40% and after immunotherapy was 9.1%. Ten studies (No = 327 patients) for Invasive Fungal Sinusitis.the results showed that combination of systematic antifungal therapy and aggressive surgical debridement are the treatment of choice. Conclusion FESS is the treatment of choice of fungal ball via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach. AFS treatment consists of surgical extirpation of the allergic mucin and polyps with maintenance of adequate sinus drainage followed by medical therapy consists of topical steroids, anti fungal therapy, Immunotherapy, and systemic corticosteroids. Treatment of invasive fungal sinusitis includes surgical resection of necrotic tissues, systemic antifungal therapy and reversal of immune dysfunction.

Sublingual Immunotherapy for Allergic Fungal Sinusitis.

Allergic fungal sinusitis (AFS) is a condition that has an allergic basis caused by exposure to fungi in the sinonasal tract leading to chronic inflammation. Despite standard treatment modalities, which typically include surgery and medical management of allergies, patients still have a high rate of recurrence. Subcutaneous immunotherapy (SCIT) has been used as adjuvant treatment for AFS. Evidence exists to support the use of sublingual immunotherapy (SLIT) as a safe and efficacious method of treating allergies, but no studies have assessed the utility of SLIT in the management of allergic fungal sinusitis. A record review of cases of AFS that are currently or previously treated with sublingual immunotherapy from 2007 to 2011 was performed. Parameters of interest included serum IgE levels, changes in symptoms, Lund-McKay scores, decreased sensitization to fungal allergens associated with AFS, and serum IgE levels. Ten patients with diagnosed AFS were treated with SLIT. No adverse effects related to the use of SLIT therapy were identified. Decreases in subjective complaints, exam findings, Lund-McKay scores, and serum IgE levels were observed. Thus, sublingual immunotherapy appears to be a safe adjunct to the management of AFS that may improve patient outcomes.

The Effect of the Oral Itraconazole on the Management of Allergic Fungal Sinusitis

The Effect of the Oral Itraconazole on the Management of Allergic Fungal Sinusitis

Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence‐based review with recommendations

Oral steroids are commonly used in the management of chronic rhinosinusitis (CRS) with and without nasal polyps (CRSwNP and CRSsNP, respectively). Past reports have included evaluation of the evidence for the use of oral steroids in CRS subtypes. However, a review with evidence-based recommendations for all CRS subtypes has never been performed. The purpose of this article is to provide a comprehensive, evidence-based approach for the utilization of oral steroids in the management of CRS. A systematic review of the literature was performed following recommendations of the Clinical Practice Guideline Manual, Conference on Guideline Standardization, and Appraisal of Guidelines and Research Evaluation. Inclusion criteria were: adult population ≥ 18 years old; CRS; oral steroids as the treatment group; and clearly defined primary clinical end-point. This review identified and evaluated the literature on the use of oral steroids for CRSwNP, CRSsNP, allergic fungal sinusitis (AFS), and the use of oral steroids in the perioperative period in these patients. Recommendations based on evidence, benefit/harm assessment, and value judgments are made. Oral steroids are strongly recommended for short-term management of CRSwNP. Oral steroids are also recommended for management of AFS. Oral steroid use in CRSsNP is optional due to insufficient strong evidence. Oral steroids are also strongly recommended in the perioperative period for CRSwNP and AFS. There is no recommendation for oral steroids use in the perioperative period in patients with CRSsNP. The risks of oral steroids are rare, but significant adverse effects must be considered.

Allergic fungal sinusitis complicated by fungal brain mass

A 36-year-old African American female with a 14-year history of allergic fungal sinusitis (AFS) presented with progressive worsening headache, fevers, proptosis, and a large frontal lobe brain mass. After excisional biopsy, the non-invasive, dematiaceous mold, Bipolaris australiensis, was identified. We review the epidemiology, etiology, pathophysiology, and clinical presentations of fungal sinusitis, as well as the complex management and multifaceted therapeutic modalities of AFS.

Management of allergic fungal sinusitis with intracranial spread

Management of allergic fungal sinusitis with intracranial spread

Management of allergic fungal sinusitis with intracranial spread

Allergic fungal sinusitis (AFS) is a form of paranasal nasal disease if not managed early often involves bone destruction and extension into the orbit and anterior skull base. We present our study of patients with AFS with intracranial, exdradural extension. This study includes our experience of 26 patients with the histological and immunological diagnosis of AFS based on findings of branching septate fungi interspersed with eosinophilic mucin and Charcot-Leyden crystals without fungal invasion of soft tissue, with intracranial extension. All had erosion of bone, which was observed on computerized tomography (CT) scans, extending intracranially and eight had disease that additionally involved the lamina papyracea. The average age of patients in this study was 25 years (range 9-46). There were 20 male and 6 female patients. All patients were immunocompetent. Skin test against aspergillin showed all patients had Type 1 hypersensitivity. All patients underwent transnasal and/or transmaxillary endoscopic approaches for debridement and eight underwent orbital decompression. No patient underwent craniotomy for removal of intracranial extradural disease. No patient had a cerebrospinal fluid leak. Postoperatively, all 26 were treated with a course of corticosteroids. The follow-up period ranged from 2 to 5 years. We conclude AFS is a unique form of fungal disease that might mimic anterior skull base and paranasal sinus tumors. Most cases can be successfully managed with transnasal and/or transmaxillary endoscopic techniques.

Presentation and management of allergic fungal sinusitis.

To assess the presentation of allergic fungal sinusitis and describe the line of management in our setup. Descriptive study. Study was conducted in Otorhinolaryngology Department, Dow Medical College and Civil Hospital, Karachi, from January 2004 to January 2005. Culture and sensitivity / fungal stain proven 20 cases of allergic fungal sinusitis were selected for the study, irrespective of age and gender. Data including age, gender, socioeconomic status, signs, symptoms, laboratory findings (especially Immunoglobulin E and eosinophil count) and imaging studies (Computed Tomography and /or Magnetic Resonance Imaging) were noted for the study. Pre and postoperative medical treatment, surgery performed, follow-up; residual/recurrence disease and revised surgery performed were also recorded. In this series, allergic fungal sinusitis was a disease of younger age group with an average age of 20.75 years with male dominance (70%). Poor socioeconomic status (80%), allergic rhinitis (100%) and nasal polyposis (100%) were important associated factors. Nasal obstruction (100%), nasal discharge (90%), postnasal drip (90%) and unilateral nasal and paranasal sinuses involvement (60%) were the commonest presenting features. Aspergillus (60%) was the most common etiological agent. In all cases (100%), increased eosinophil count and IgE levels were present. Orbital (20%) and intracranial (10%) involvement were also seen. Surgical management was preferred in all cases. Functional endoscopic sinus surgery in 90% cases and lateral rhinotomy in 10% cases were performed. Recurrence / residual disease was seen in 20% cases. In this series, allergic fungal sinusitis was seen in immunocompetent, young males, belonging to poor socioeconomic status, suffering from allergic rhinitis and nasal polyposis, presenting with nasal obstruction, nasal discharge and postnasal drip. Functional endoscopic sinus surgery was the most important problem solving procedure while lateral rhinotomy was reserved for extensive disease.

Itraconazole in the treatment of refractory allergic fungal rhinosinusitis

Objectives: The conventional management of allergic fungal sinusitis (AFS) after surgery consists of systemic and topical steroids to immunomodulate the body’s response to fungi. However, there are significant side effects to prolonged steroid use and there are a group of patients who are unresponsive to standard treatment. The role of systemic antifungal drugs in AFS is still largely unknown. This pilot study was carried out to evaluate the effectiveness of itraconazole, an oral antifungal drug in the treatment of refractory AFS. Methods: Twenty-four patients with AFS who had had image-guided surgery and were refractory to prednisone, topical steroid, and Amphotericin B nasal sprays were treated with itraconazole for at least 3 months. All patients were evaluated with pre- and posttreatment endoscopic examinations, serum IgE and RSOM-31 questionnaires. Monthly liver function tests were done to monitor for hepatic side effects of itraconazole. Results: Nine patients had an improvement in endoscopic stage. Nine had no difference and 5 had a worse endoscopic stage after 3 months. One patient had to stop treatment due to abnormal liver function tests. Mean pretreatment IgE was 722 μg/L and posttreatment IgE was 700 μg/L. Subjectively, 7 patients reported significant improvement, 8 had moderate improvements, and 8 reported little or no change. No correlation was noted between the subjective and the endoscopic findings. Conclusions: Itraconazole appears to have a modest benefit as an adjunct in the management of refractory AFS. Steroids continue to remain the mainstay of treatment and more research is needed to define the role of systemic antifungal drugs.

Treatment of Allergic Fungal Sinusitis with High-Dose Itraconazole

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. 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. 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. 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.

Allergic fungal sinusitis: The role of immunotherapy

The role of surgery and anti-inflammatory therapy (such as corticosteroids) in the management of allergic fungal sinusitis is accepted fairly universally. Although once thought to be contraindicated in the treatment of allergic fungal sinusitis, specific immunotherapy with fungal antigens has been shown to be extremely beneficial to these patients, when combined with surgery and adjunctive medical management. Recurrences have been prevented and systemic corticosteroid requirements virtually eliminated in an experience that now spans over 4 years.

Allergic fungal rhinosinusitis: Surgical management

Allergic fungal sinusitis is a newly characterized disease entity that has commanded a great deal of interest over the past 2 decades. As more information is gathered about its underlying etiology, clinical presentation, and response to therapy, the treatment of allergic fungal sinusitis is becoming more refined. Most current treatment protocols for allergic fungal sinusitis are based upon a combined surgical and medical approach. This article addresses pertinent surgical aspects as related to the management of allergic fungal sinusitis.

The Diagnosis and Management of Allergic Fungal Sinusitis

Educational objectives: To distinguish all types of fungal sinusitis, including allergic fungal sinusitis, and to understand the proper management of allergic fungal sinusitis on the basis of our current understanding of its pathophysiology.

Allergic Fungal Sinusitis

Fungal sinusitis can present as one of four distinct clinicopathologic entities: 1) fulminant or acute; and three types of chronic, 2) indolent, 3) mycetoma, and 4) allergic fungal sinusitis (AFS). The first three forms differ both clinically and pathologically from AFS. The first reported cases of AFS were associated with the fungus Aspergillus, but recently other fungal organisms have been implicated. Five different fungal organisms have been found to cause AFS in 14 patients. The prevalence of AFS among patients with chronic sinusitis may be as high as 7%. The diagnosis is made on the histologic findings of inspissated allergic mucin containing 1) numerous eosinophils, 2) scattered noninvasive fungal hyphae, and 3) Charcot-Leyden crystals. In addition, AFS patients have a characteristic clinical and immunologic profile. The clinical presentation, diagnosis, and management of AFS are discussed. Uniformity of the classification of fungal sinusitis is proposed.