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Allergic fungal sinusitis in the pediatric population
1Division of Otolaryngology, Medical College of Georgia, Augusta, USA.
Objective:
To determine the optimal treatment in pediatric patients with allergic fungal sinusitis (AFS).
Design:
A retrospective review of 10 patients diagnosed as having AFS.
Setting:
Academic tertiary medical center.
Patients:
Pediatric patients who fulfilled 5 criteria necessary for diagnosis of AFS: (1) type 1 hypersensitivity; (2) nasal polyposis; (3) characteristic computed tomographic scan; (4) histological evidence of eosinophilic mucus without evidence of fungal invasion into sinus tissue; and (5) a positive fungal stain or culture of sinus contents.
Treatment:
All patients were treated with functional endoscopic sinus surgery with removal of fungal debris. Adjuvant therapy included nasal irrigations, postoperative endoscopic cleanings, and systemic corticosteroids in 9 of 10 patients.
Mean Outcome Measure:
Clinical disease monitored endoscopically by means of an objective staging system.
Results:
Five patients were without disease (stage 0), 1 had allergic mucin and mucosal edema (stage I), 1 had allergic mucin and polypoid edema (stage II), and 3 had polyps and/or fungal debris (stage III).
Conclusions:
The treatment and prognosis of pediatric AFS are similar to those of adult AFS. However, systemic corticosteroids should be weaned aggressively in children to minimize complications, particularly long-term growth retardation.