Hostname: page-component-6766d58669-bp2c4 Total loading time: 0 Render date: 2026-05-20T11:26:38.074Z Has data issue: false hasContentIssue false
  • English
  • Français

Allergic fungal rhinosinusitis with skull base and orbital erosion

Published online by Cambridge University Press:  03 December 2009

M S Marfani ,
M A Jawaid ,
S M Shaikh  and
K Thaheem
M S Marfani*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Dow University of Health Sciences, Dow Medical College and Civil Hospital, Karachi, Pakistan
M A Jawaid
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Dow University of Health Sciences, Dow Medical College and Civil Hospital, Karachi, Pakistan
S M Shaikh
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Dow University of Health Sciences, Dow Medical College and Civil Hospital, Karachi, Pakistan
K Thaheem
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Dow University of Health Sciences, Dow Medical College and Civil Hospital, Karachi, Pakistan
*
Address for correspondence: Prof. Dr Muhammad Saleem Marfani, Chairman, ENT Dept, Dow University of Health Sciences, Dow Medical College, ENT Unit II, Civil Hospital, Baba-e-Urdu Road, Karachi, Postal code 74200, Pakistan. E-mail: duhsent2@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Allergic fungal rhinosinusitis is a benign, noninvasive sinus disease related to hypersensitivity to fungal infection having bony skull base and orbital erosion as common finding.

Patients and method:

This descriptive study was conducted at the department of otorhinolaryngology, Dow University of Health Sciences, Karachi, Pakistan, from April 2003 to March 2006. In forty-seven proven cases of allergic fungal sinusitis the following information was recorded: demographic data, signs and symptoms, laboratory investigation results, imaging results, pre- and post-operative medical treatment, surgery performed, follow up, and residual or recurrent disease. The Statistical Package for the Social Sciences version 10.0 software was used for data analysis.

Results:

Findings indicated that allergic fungal rhinosinusitis usually occurred in the second decade of life (51.06 per cent) in males (70.21 per cent), allergic rhinitis (100 per cent) and nasal polyposis (100 per cent). Nasal obstruction (100 per cent), nasal discharge (89.36 per cent), postnasal drip (89.36 per cent), and unilateral nasal and paranasal sinus involvement (59.57 per cent) were significant features. Aspergillus (59.57 per cent) was the most common aetiological agent. Combined orbital and skull base erosion was seen in 30.04 per cent of cases, with male preponderance 6.8:1. Endoscopic sinus surgery was performed in all cases, and recurrent or residual disease was observed in 19.14 per cent.

Conclusion:

Allergic fungal rhinosinusitis is a disease of young, immunocompetent individual. Skull base and orbital erosion are seen in one-third of cases. Bone erosion is 6.8 times more common in males than females. Orbital erosion is 1.5 times more common than skull base erosion. Endoscopic surgical debridement and drainage combined with topical steroids leads to resolution of disease in the majority of cases, without resorting to systemic antifungal agents, craniotomy or dural resection.

Keywords

SinusitisFungusAspergillusEndoscopyComputed Tomography

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 2 , February 2010 , pp. 161 - 165
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Presented at the 26th Asian International Symposium on Infection and Allergy of the Nose, 1–4 February 2007, Kaulalumpur, Malaysia.

References

1Liu, JK, Schaefer, SD, Muscatello, AL, Couldwell, WT. Neurosurgical implications of allergic fungal sinusitis. J Neurosurg 2004;100:883–90CrossRefGoogle ScholarPubMed
2Shubert, MS. Allergic fungal sinusitis. Otolaryngol Clin North Am 2004;37:301–26CrossRefGoogle Scholar
3Kinsella, JB, Rassekh, CH, Bradfield, JL, Chaljub, G, McNee, SW, Gourley, WK et al. Allergic fungal sinusitis with cranial base erosion. Head Neck 1996;18:211–173.0.CO;2-2>CrossRefGoogle ScholarPubMed
4Khun, FA, Swain, RJ. Allergic fungal sinusitis: diagnosis and treatment. Curr Opin Otolaryngol Head Neck Surg 2003;11:1–5Google Scholar
5Granvilla, L, Chirala, M, Cernoch, P, Ostrowski, M, Truong, LD. Fungal sinusitis: histologic spectrum and correlation with culture. Hum Pathol 2004;35:474–81Google Scholar
6Ponikau, JU, Sherris, DA, Kern, EB, Homburger, HA, Frigas, E, Gaffey, TA et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 1999;74:877–84Google Scholar
7Hsiao, CH, Li, SY, Wang, JL, Liu, CM. Clinicopathologic and immunohistochemical characteristics of fungal sinusitis. Formos Med Assoc 2005;104:549–56Google Scholar
8Ghegan, MD, Lee, FS, Schlosser, RG. Incidence of skull base and orbital erosion in allergic fungal rhinosinusitis (AFRS) and non-AFRS. Otolaryngol Head Neck Surg 2006;134:592–5CrossRefGoogle ScholarPubMed
9Nussenbaum, B, Marple, BF, Schwade, ND. Characteristics of bony erosion in allergic fungal rhinosinusitis. Otolaryngol Head Neck Surg 2001;124:150–4CrossRefGoogle ScholarPubMed
10Gupta, AK, Ghosh, S, Gupta, AK. Sinonasal aspergillosis in immunocompetent Indian children: an eight-year experience. Mycoses 2003;46:455–61Google Scholar
11Uri, N, Cohen-Kerem, R, Elmalah, I, Doweck, I, Greenberg, E. Classification of fungal sinusitis in immunocompetent patients. Otolaryngol Head Neck Surg 2003;129:372–8CrossRefGoogle ScholarPubMed
12Schubert, MS. Fungal rhinosinusitis: diagnosis and therapy. Curr Allergy Asthma Rep 2001;1:268–76CrossRefGoogle ScholarPubMed
13Mian, MY, Kamal, SA, Senthilkumaran, G, Abdullah, A, Pirani, M. Allergic fungal rhinosinusitis: current status. Pak J Otolaryngol 2002;18:36–40Google Scholar
14Iqbal, K, Saqlain, G, Jalisi, M. Nasal polyposis and fungal sinusitis – efficacy of Caldwell Luc as a therapeutic procedure. Pak J Otolaryngol 1993;9:173–6Google Scholar
15Akhtar, MR, Ishaque, M, Saadat, U. Aetiology of nasal polyp – a study of 200 cases at Combined Military Hospital Rawalpindi. Pak J Otolaryngol 2004;20:9–11Google Scholar
16Rashid, D, Ahmed, B, Muhammad, SM, Hydri, AS. Fungal, sinusitis. J Coll Physicians Surg Pak 1999;9:381–3Google Scholar
17McCann, WA, Cromie, M, Chandler, F, Ford, J, Dolen, WK. Sensitization to recombinant Aspergillus fumigatus allergens in allergic fungal sinusitis. Ann Allergy Asthma Immunol 2002;89:203–8CrossRefGoogle ScholarPubMed
18Panda, NK, Sharma, SC, Chakrabarti, A, Mann, SB. Paranasal sinus mycoses in north India. Mycoses 1998;41:281–6CrossRefGoogle ScholarPubMed
19Schubert, MS, Goetz, DW. Evaluation and treatment of allergic fungal sinusitis. I. Demographics and diagnosis. J Allergy Clin Immunol 1998;102:387–94CrossRefGoogle ScholarPubMed
20deShazo, RD, Chapin, K, Swain, RE. Fungal sinusitis. N Engl J Med 1997;337:254–9Google Scholar
21Lund, VJ, Lloyd, G, Savy, L, Howard, D. Fungal rhinosinusitis. J Laryngol Otol 2000;114:76–80CrossRefGoogle ScholarPubMed
22Schubert, MS. Medical treatment of allergic fungal sinusitis. Ann Allergy Asthma Immunol 2000;85:90–7CrossRefGoogle ScholarPubMed
23Mabry, RL, Manning, S. Radioallergosorbent microscreen and total immunoglobulin E in allergic fungal sinusitis. Otolaryngol Head Neck Surg 1995;113:721–3CrossRefGoogle ScholarPubMed