Sinus

Allergic Fungal Sinusitis

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Allergic Fungal Sinusitis

  • Epidemiology
  1. Affects immunocompetent children and young adults
  2. Higher Prevalence in warm, humid environments
  3. Accounts for 7% of Chronic Sinusitis requiring surgery
  • Associated Conditions
  1. Asthma (33%)
  2. Aspirin sensitivity is not related
  3. Atopy
  • Signs
  1. Nasal Polyps
  2. Chronic pansinusitis refractory to standard therapy
  • Labs
  • Sinus mucus examination
  1. Charcot Leyden crystals
  2. Non-invasive hyphae
  3. Numerous Eosinophils
  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
  • Differential Diagnosis
  1. Sinonasal neoplasm
  2. Fungal Sinusitis
  3. Bacterial Acute Sinusitis
  • Labs
  1. Total IgE elevated (often exceeds 1000)
  • Management
  1. Surgical debridement
  2. Immunotherapy with fungal and non-fungal antigens
  3. Corticosteroids
  4. Irrigation and self-cleansing by patient