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Allergic fungal sinusitis: learning from our failures.

B F Marple¹, R L Mabry

¹University of Texas Southwestern Medical Center, Dept. of Otolaryngology-Head and Neck Surgery, Dallas 75390-9035, USA.

American Journal of Rhinology

|September 9, 2000

Summary

Allergic fungal sinusitis (AFS) treatment combining surgery, steroids, and immunotherapy can recur. Treatment failure in AFS is linked to poor immunotherapy compliance and incomplete surgical removal of allergic mucin.

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Area of Science:

Otolaryngology-Head and Neck Surgery
Allergen Immunology

Background:

Allergic fungal sinusitis (AFS) management at UT Southwestern utilizes a multimodal approach: surgery, perioperative corticosteroids, and immunotherapy.
Previous reports indicated initial success with this AFS treatment regimen.

Observation:

Continued experience revealed cases of AFS recurrence despite the established treatment protocol.
Recurrence cases were carefully reviewed to identify contributing factors.

Findings:

Two primary factors identified as leading to treatment failure in AFS: non-compliance with immunotherapy and insufficient surgical resection of allergic mucin.
Inadequate initial surgical extirpation of all allergic mucin compromises long-term AFS management.

Implications:

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Optimizing AFS treatment requires addressing patient adherence to immunotherapy.
Ensuring comprehensive surgical clearance of allergic mucin is critical for preventing AFS recurrence.
Further investigation into refining surgical techniques and immunotherapy protocols for AFS is warranted.