Sinonasal Anatomic Variants in Allergic Fungal Rhinosinusitis

Area of Science:

• Otolaryngology
• Immunology
• Radiology

Background:

• The underlying mechanisms of allergic fungal rhinosinusitis (AFRS) remain incompletely understood.
• Investigating anatomical factors may provide insights into AFRS pathophysiology.

Purpose of the Study:

• To determine the prevalence of sinonasal anatomic variants (AVs) in patients diagnosed with AFRS.
• To compare the incidence of specific AVs between AFRS-affected and healthy sinonasal sides.

Main Methods:

• Retrospective cohort study of 155 AFRS patients from 2008-2018.
• Analysis of preoperative sinus CT scans for unilateral AFRS cases, comparing affected and unaffected sides.
• Evaluation of agger nasi (AN), Haller's cells (HC), concha bullosa (CB), and supraorbital ethmoid cells (SOEC).

Main Results:

• Anatomic variants were present in 86.7% of AFRS-affected sides versus 70% of healthy sides.
• Concha bullosa (CB) was significantly more prevalent in AFRS-affected sides (40%) compared to healthy sides (3%) (p=0.0006).
• Haller's cells (HC) showed a trend towards increased prevalence in AFRS-affected sides (23.3%) versus healthy sides (6.7%) (p=0.071).

Conclusions:

• Anatomic variants, particularly concha bullosa, are more common on the side affected by AFRS.
• The findings suggest a potential role for AVs, especially CB, in the pathophysiology of AFRS.
• Further research is warranted to elucidate the specific association between AVs and AFRS development.