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Radiographic Nuances in Allergic Fungal Rhinosinusitis

Nicholas R Rowan1,2, Tyler A Janz2, Rodney J Schlosser2,3

  • 11 Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

American Journal of Rhinology & Allergy
|January 25, 2019
PubMed
Abstract

Insights

Allergic fungal rhinosinusitis (AFRS) shows higher rates of revision endoscopic sinus surgery (ESS). Concha bullosa, an anatomical variation, is more common in AFRS patients and may contribute to recurrent disease.

Area of Science:

  • Otolaryngology
  • Radiology
  • Immunology

Background:

  • Allergic fungal rhinosinusitis (AFRS) presents with distinct radiographic features and higher revision endoscopic sinus surgery (ESS) rates compared to chronic rhinosinusitis.
  • Understanding these differences is crucial for effective treatment and management.

Purpose of the Study:

  • To investigate the hypothesis that anatomical variations, such as concha bullosa, contribute to allergic mucin accumulation and increased ESS revision rates in AFRS.
  • To identify radiographic nuances associated with AFRS.

Main Methods:

  • A retrospective cohort study involving 210 patients diagnosed with AFRS, chronic rhinosinusitis with nasal polyposis (CRSwNP), or chronic rhinosinusitis without nasal polyposis (CRSsNP).
  • Data collected included diagnosis, demographics, prior ESS rates, and radiographic features like concha bullosa prevalence.

Main Results:

  • AFRS patients were younger, more likely to be African American, and had higher rates of prior ESS compared to CRSwNP and CRSsNP groups.
  • Concha bullosa prevalence was significantly higher in AFRS patients (42.9%) than in CRSwNP (18.6%) or CRSsNP (14.3%) patients.
  • Pediatric AFRS patients exhibited more unilateral disease and anterior ethmoid skull base erosion.

Conclusions:

  • Concha bullosa is a more prevalent anatomical finding in AFRS patients, irrespective of prior ESS.
  • This anatomical variation may serve as a site for recurrent or residual disease in AFRS.
  • Surgeons should consider concha bullosa in the management of AFRS to address potential disease reservoirs.
Keywords:
allergic fungal rhinosinusitisallergic fungal sinusitischronic rhinosinusitischronic sinusitisconcha bullosaendoscopic sinus surgerynasal polyposisnasal polyps

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