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

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Footnotes

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

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