II. Epidemiology

  1. Affects immunocompetent children and young adults
  2. Higher Prevalence in warm, humid environments
  3. Accounts for 7% of Chronic Sinusitis requiring surgery

III. Associated Conditions

  1. Asthma (33%)
  2. Aspirin sensitivity is not related
  3. Atopy

IV. Signs

  1. Nasal Polyps
  2. Chronic pansinusitis refractory to standard therapy

V. Labs: Sinus mucus examination

  1. Charcot Leyden crystals
  2. Non-invasive hyphae
  3. Numerous Eosinophils

VI. Radiology: Sinus XRay Findings

  1. Complete opacification of multiple sinuses
  2. Extension beyond sinus
  3. Wall erosion of involved sinus
  4. Scattered areas of high attenuation
  5. Mucosal thickening

VII. Differential Diagnosis

  1. Sinonasal neoplasm
  2. Fungal Sinusitis
  3. Bacterial Acute Sinusitis

VIII. Labs

  1. Total IgE elevated (often exceeds 1000)

IX. Management

  1. Surgical Debridement
  2. Immunotherapy with fungal and non-fungal Antigens
  3. Corticosteroids
  4. Irrigation and self-cleansing by patient

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