Introduction
Allergic fungal rhinosinusitis (AFRS) is a chronic disorder with significant morbidity and a high recurrence rate needing long-term follow-up. Even after its first description many decades ago, there is still considerable uncertainty about the management of this condition.
Description
In this chapter, we breakdown the topic “Optimal management of allergic fungal rhinosinusitis” into sub-headings in order to discuss the latest research and available literature under each topic in great detail. Every attempt has been made to incorporate the highest level of evidence that was available at the time of writing.
Summary
Pre-operative diagnosis and further management prior to surgery is important. Steroids help in reducing inflammation and help improve the surgical field. Surgery remains the mainstay in the management of this condition along with long-term medical management. Oral steroids are reserved for acute flare-ups in the background of associated lung concerns. Oral and topical antifungal agents have no role in the control of the disease. Biological agents are being prescribed predominantly by respiratory physician colleagues, mainly for the control of the chest-related issues rather than for sinus disease. Immunotherapy as an adjunct with surgery is promising.
Conclusion
AFRS is a disease with many variables and a wide range of symptomatic presentation. It takes a keen clinician to identify the disease and subsequently manage the condition. Treatment involves long-term follow-up with early detection of recurrence or flare-ups. Any of the mentioned modalities of management may be employed to effectively control the condition, and treatment protocols will have to be tailor-made to suit each individual patient. Various medications and drugs such as Manuka honey, antimicrobial photodynamic therapy, hydrogen peroxide and betadine rinses appear to be promising. More robust studies need to be undertaken to ascertain their routine use in clinical practice.
Nasal septal perforations can be caused by a number of aetiology including intra-nasal drug abuse, trauma and iatrogenic causes. These defects can present in various sizes and shapes; conventionally classified into small (<1 cm), moderate (1-2 cm) and large (>2 cm). 1 Although there are many surgical techniques to close a nasal septal perforation (NSP), the success rate can be limited by size of perforation, reduced donor area, active sinonasal disease or active intra-nasal drug abuse or experience of the surgeon. In scenarios where surgical closure is not indicated or feasible, a prosthesis such as a septal button can be a useful treatment modality to improve sino-nasal symptoms and reduce the impact of qualityof-life due to the nasal septal defect. 2 Conventional septal buttons, do not always provide a good fit, especially in large perforations and may result in migration and extrusion of the prosthesis. Some studies have indicated poor tolerance with conventional buttons despite reduction in symptom scores. 3 The utility of three-dimensional (3-D) printing technology is increasingly widespread in modern reconstructive surgery. Not only is it being used to create bionic parts to replace tissue but also for surgical training, surgical simulation and planning.
IMPORTANCE Augmentation rhinoplasty is common in the Asian population and the lack of suitable autologous material for augmentation has led to the use of alloplastic materials. Many of these patients develop complications, including a depressed dimple-like scar of the nasal tip. Causes of such dimpling include the use of large implants, infection, extrusion, and surgeon incompetence.OBJECTIVE To describe the various techniques that can be used to correct dimpling of the nasal tip.
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