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Fungal rhinosinusitis: diagnosis and therapy

M S Schubert1

  • 1Allergy Asthma Clinic, Ltd, 31 W Camelback Road, Phoenix, AZ 85013, USA.

Current Allergy and Asthma Reports
|March 15, 2002
PubMed

Insights

Allergic fungal sinusitis (AFS) is the most common fungal rhinosinusitis. Diagnosis involves histopathology, and treatment requires surgery with medical management, though recurrence rates remain high.

Area of Science:

  • Otolaryngology
  • Allergy and Immunology
  • Mycology

Background:

  • Fungal rhinosinusitis encompasses five clinicopathologic forms: invasive (acute fulminant, chronic, granulomatous) and noninvasive (fungal ball, allergic fungal sinusitis - AFS).
  • Allergic fungal sinusitis (AFS) is the most prevalent form, affecting immunocompetent, atopic individuals with chronic rhinosinusitis and nasal polyps.
  • Clinical presentation may include nasal casts and proptosis due to orbital extension.

Purpose of the Study:

  • To delineate the clinicopathologic characteristics, diagnostic criteria, treatment strategies, and prognostic factors of fungal rhinosinusitis, with a focus on AFS.

Main Methods:

  • Diagnosis relies on surgical histopathology, identifying extramucosal allergic mucin with fungal hyphae and eosinophilic-lymphocytic inflammation, often supplemented by fungal cultures.
  • Sinus CT imaging reveals mucosal hypertrophy and sinus content hyperattenuation.

Main Results:

  • Bipolaris spicifera is the most frequently cultured fungus in AFS.
  • The immunopathology of AFS mirrors that of allergic bronchopulmonary aspergillosis.
  • Histopathology confirms allergic mucin with scattered fungal elements and inflammatory infiltrates.

Conclusions:

  • Effective treatment for AFS necessitates surgical intervention combined with aggressive postoperative medical management, including allergy medications, immunotherapy, and potentially oral corticosteroids.
  • Despite improved outcomes with medical management, high recurrence rates underscore the need for further research and optimized treatment protocols.

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