Allergic Fungal Rhinosinusitis in Baquba

Rhinosinusitis

Abstract

Background: Allergic fungal rhinosinusitis (AFRS) was a unique variant of chronic rhinosinusitis. It is one type of fungal rhinosinusitis which is divided into invasive and non invasive disease. It has variable modes of presentations and managements. It represents a challenge in diagnosis and management and have high rate of recurrence.
Objectives: To enhance the diagnostic ability for AFRS by clarifying its common presentations and to declare the role of local and systemic steroids in decreasing the rate of its recurrence.
Design: A prospective study.
Setting: Department of Otolaryngology Head and Neck Surgery. Baquba Teaching Hospital, Diyala, Iraq.
Patients: Forty patients with chronic rhinosinusitis with and without nasal polyps attending consultation unit of E.N.T from January 2019 to July 2020.
Methods: Patients were evaluated by thorough history and examination of nose and paranasal sinuses. Demographic and clinical
characteristics were gathered using a predesigned questionnaire form which include gender, age, residency, occupation and main symptoms as nasal obstruction(unilateral or bilateral), nasal discharge (anterior and posterior),facial pain and headache, sneezing, loss or decrease of smell, snoring and epistaxis. Past surgical history of nose as nasal polypectomy either endoscopic or conventional surgery. Past medical history of allergic rhinitis and asthma and other types of allergy recorded. Investigations that include plain sinus x- ray and computed tomography (CT) scan of nose and paranasal sinuses for all patients. Skin test for fungal antigen done for all patients. Histopathological and fungal study was also done for materials removed surgically. The patients received systemic steroid therapy as prednisolone tablet in high doses pre and post operatively and local steroid such as mometasone or fluticasone nasal spray with antifungal (fluconazole) for few months. All patients required surgical treatment by endoscopic surgery in E.N.T. department.
Results: Most patients were below the age of thirty (28=70%). There was an equal incidence in males and females 1:1.Most common symptom was nasal obstruction in all patients, unilateral nasal obstruction (24=60%) and bilateral in others, followed by nasal discharge(70%), sneezing (70%), anosmia and hyposmia (70%), facial pain (40%), and snoring. Nasal polyp was the most common sign (32=80%) with half of them in unilateral site and other half in both nasal cavities, post nasal drip(40%) and orbital proptosis (10%).Majority of patients had association with allergic history as allergic rhinitis and asthma (28=70%). All the patients required surgical debridement (100%) and prolonged systemic and local steroids to decrease recurrence.
Conclusion: Diagnosis and management of allergic fungal sinusitis represent a continuous clinical heath problem. CT scan is important for the diagnosis of AFRS. It is a disease of young immunocompetent patients with equal sex predominance and multiple recurrences. Prolonged local and systemic steroid therapy and adequate surgical debridement is crucial to decrease recurrences.