(The surgical treatment aims at complete removal of all fungal mass from the sinuses. This is best achieved by a radical antromy and FESS combined as shown in this video clip. The procedure is done in Jubilee Hospital, Trivandrum, Kerala, India.)
Patients diagnosed with AFS have a history of allergic rhinitis and symptoms of chronic sinusitis not responding to antibiotic treatment. It is believed to be an allergic reaction to environmental fungi that is finely dispersed into the air.
Allergic fungal sinusitis is characterized by the presence of mucin, which is a combination of fungus and mucus that builds up in the sinus cavity and creates nasal blockage. The mucin ranges in color from tan to dark green or even black. The symptoms of infection include fever, swelling around the eyes, a pus-filled discharge from the nose and throat, headaches, earaches, and pain in the teeth or face. Some people also experience a stuffy nose, sore throat or cough. In severe cases of allergic fungal sinusitis, the sinus blockage can press outward, making the face and eyes appear uneven or asymmetrical.
These patients will present with a typical symptoms of chronic sinusitis, but perhaps have less pain than some patients.
CT imaging of sinuses will show as an area of increased density, or some brighter spots, and the sinuses. In advanced stage there will be expansion and erosion to the surrounding structures.
(Here video clip shows the surgical treatment for a non invasive fungal mass arising from the right maxillary antrum eroding the medial wall of the sinus and presented as bleeding polyp. Chronic fungal rhinosinusitis can occur in otherwise healthy host and Aspergillus is the common etiological agent in Indian scenario.)
Treatment of allergic fungal sinusitis requires both medical and surgical intervention. Prior to the surgery, if fungus is recognized or suspected, a short burst of oral corticosteroid may shrink the polyps and allow for the patient to breathe more easily. Shrinking the polyps also helps make the surgery easier and helps the surgeon eliminate all the small pockets of fungus.
(For non-invasive Allergic fungal sinusitis disease requires surgical treatment by radical antrostomy (caldwel luc) and FESS and followed by antifungal and corticosterold therapy. Itraconazole or ketoconazole has been found as an effective antifungal given for a short period after surgery.)
Surgery for allergic fungal sinusitis usually requires complete cleaning of the nose and sinuses. Radical surgical treatment is necessary. All the nooks and crannies in the nose and sinuses that might be harboring bits of fungus must be opened and cleaned out. This can be better achieved by a Caldwell Luc and FESS approach. It\’s very important that all the areas containing fungus are adequately examined and cleaned of the fungal debris.
To avoid any recurrence, medical treatment with antifungal, corticosteroid and anti inflammatory drugs are given.
After surgery, it is important that the patients irrigate their nose with salt water to help remove any small bits of microscopic disease.
