Allergic Fungal Rhinosinusitis: A Case Study

Fungal sinusitis is generalized as invasive and non-invasive types. The invasive type has fungal hyphae in the mucosa, submucosa, bones, or in vascular channels of the paranasal sinuses and consists of Acute Invasive Fungal Sinusitis, Acute Fulminant, Chronic Invasive Fungal Sinusitis, and Chronic Granulomatous Fungal Sinusitis. Invasive types of fungal rhinosinusitis are uncommon and limited to populations of patients who are immunocompromised. The non-invasive type shows a lack of fungal hyphae in the mucosa of the paranasal sinuses. It consists of Allergic Fungal Rhinosinusitis and fungus ball (fungus mycetoma). The study was done on a total of 10 patients of AFRS in the Department of Otorhinolaryngology at our hospital diagnosed with allergic fungal sinusitis and observed their diverse clinical presentations and treatments over the course of 1 year. The study was done prospectively. Patients presenting with features of allergic fungal rhinosinusitis were included. Patients diagnosed with chronic granulomatous infection of the nose and invasive fungal sinusitis were excluded. The evaluation of patients consisted of history-taking and clinical examination followed by radiologic evaluation. After obtaining proper permission, we undertook a study of 10 patients who presented to the outpatient department with complaints of sinusitis. . Among these patients, all of them had complaints of frequent sneezing, nose block, nasal discharge and facial heaviness. All of them had olfactory disturbances, reduced perception of smell. All of these patients in our case series were in the age group of 20–60 years. The patients were given a course of nasal sprays and pre-operative steroids in cases of extensive polyposis and were taken up for functional endoscopic sinus surgery. The polypoidal mucosa was excised, diseased tissue was cleared, sinus blockages were relieved, and fungal mucin/tissue bits were sent for histopathology, KOH mount, and fungal culture. This study consisted of a series of cases that presented with a wide variety of different clinical presentations of allergic fungal rhinosinusitis, along with its diagnosis and treatment. The value of this study was that we analyzed a good number of cases with varied presentations. As AFRS is closely associated with EMRS and CRS, proper clinical, radiological, and immunological evaluation of cases helps in making an accurate diagnosis and selecting the appropriate treatment.