Allergic Fungal Sinusitis in India (AFS)-Pre and Post op Follow Up
Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, South India.
Allergic Fungal SinusitisÂ is not uncommon in southern part of India. I see increasing number of patients more in younger age group than older, mainly those coming from the villages. They were more common in diabetics and immuno-compromised patients, but not any more.
Allergic fungal sinusitis is a benign noninvasive sinus disease, believed to be an allergic reaction to environmental fungi that is finely dispersed into the air. Patients diagnosed with AFS always have history of allergic rhinitis; characteristic features of allergic fungal sinusitis are signs or symptoms of chronic sinusitis unresponsive to antibiotic therapy. The disease leads to progressive destruction of the sinuses and can invade the bony cavities containing the eyeball and brain. Patients with AFS may have allergies, nasal polyps and may have asthma too.
Diagnosis of Allergic Fungal Sinusitis
The presence of allergic mucin is a reliable diagnosis of fungal sinusitis. Patients may also be tested for invasive fungal sinusitis, saprophytic fungal growth, mycetoma, aspergilloma, fungus ball of the sinuses and eosinophilic mucin sinusitis to assist in confirming both a positive or negative diagnosis of AFS.
CT Imaging shows the extent of the infection. There will be increased intrasinus attenuation at non-contrast material-enhanced CT. Expansion of sinuses, extensive bone erosion, lack of contrast enhancement, multiple sinus involvement; with orbital involvement were other characteristics of AFS.
Treatment of Allergic Fungal Sinusitis
Surgical removal of the thick fungal debris and mucin in the infected sinuses is the most effective way to treat AFS. Endoscopic sinus surgery must be used in conjunction with long-term medical therapy, ie, oral and nasal corticosteroids, immunotherapy, antifungal therapy, and antimicrobial agents to effectively control the problem.
Steroids must be given before and after the surgery. Recurrence of AFS is not uncommon and patients may require additional surgeries. Immunotherapy and anti-inflammatory therapy may also be used to eliminate the fungal colonies.
Post Op Follow Up After One Year:
Pre and Post Op CT Images after one Year Follow Up:
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