Objectives: The objective of this study was to compare the efficacy of itraconazole and systemic steroids as an adjuvant to topical steroids in post-operative patients with allergic fungal rhinosinusitis (AFRS) using both subjective and objective outcome measurements.Design: A prospective comparative study.Setting: A tertiary care centre.Participants: Sixty patients diagnosed with AFRS were included. Patients with chronic systemic illness and those undergoing revision surgery were excluded. Postoperative patients were divided into two groups of 30 each which received itraconazole 400 mg OD or methylprednisolone in tapering doses over 6 weeks.
Main outcome measures:The outcomes were measured at the end of 6 weeks-Kupferberg endoscopic staging, absolute eosinophilic count (AEC), serum immunoglobulin (IgE), and Sino Nasal Outcome Test-20 scores.Results: Our study showed no statistical significance in outcomes between the two groups treated with itraconazole and methylprednisolone regarding recurrence, AEC, IgE and quality of life assessment (p < 0.01).
Conclusion:Itraconazole was comparable to methylprednisolone in preventing disease recurrence in the post-operative management of AFRS. It may be a viable alternative to replacing systemic steroids where the latter may be contraindicated.Itraconazole given at a dose of 400 mg once daily for 6 weeks was a safe dose.
Title: A prospective study comparing Itraconazole and systemic steroids
as an adjunct to topical steroids in the post-operative management of
Allergic fungal rhinosinusitis ABSTRACT Objectives The objective of this
study was to compare the efficacy of Itraconazole and systemic steroids
as an adjuvant to topical steroids in post-operative patients with
Allergic Fungal Rhinosinusitis (AFRS) using both subjective and
objective outcome measurements. Methods A prospective comparative study
was conducted in a tertiary care center on 60 patients diagnosed with
AFRS. Patients with chronic systemic illness and those undergoing
revision surgery were excluded. Post-operative patients were divided
into two groups of 30 each which received Itraconazole 400 mg OD or
Methylprednisolone in tapering doses over six weeks. The outcomes were
measured at the end of 6 weeks -Kupferberg endoscopic staging, Absolute
Eosinophilic Count (AEC), Serum Immunoglobulin (IgE), and Sino Nasal
Outcome Test - 20 scores. Results Our study showed no statistical
significance in outcomes between the two groups treated with
Itraconazole and Methylprednisolone regarding recurrence, AEC, IgE, and
Quality of Life Assessment (p<0.01). Conclusion Itraconazole
was comparable to Methylprednisolone in preventing disease recurrence in
the post-operative management of AFRS. It may be a viable alternative to
replacing systemic steroids where the latter may be contraindicated.
Itraconazole given at a dose of 400 mg once daily for six weeks was a
safe dose. Keywords: Allergic Fungal Rhinosinusitis, Itraconazole,
endoscopy, Quality of Life, Methylprednisolone Key points: •
Itraconazole was comparable to systemic steroid (Methylprednisolone) in
preventing disease recurrence in the post-operative management of AFRS.
• It may be a viable alternative to replacing systemic steroids where
the latter may be contraindicated. • Itraconazole given at a dose of 400
mg once daily for six weeks was a safe dose. • Recurrence may be treated
safely with Itraconazole than with steroids. • The course may be
repeated in case of recurrence with close monitoring.
Patients with chronic rhinitis causing intractable sneezing which is non-responsive to conventional medication require alternative therapies. The aim of the study was to ascertain the effect of topical 10% silver nitrate solution on the inferior turbinate mucosa as well as quality of life in such patients. Patients with severe chronic rhinitis who failed conventional therapy had application of 10% silver nitrate solution to inferior turbinate mucosa. The number of sneezes/day and mini Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was noted before and 8 to 16 weeks after treatment. Pre- and post treatment turbinate biopsies were performed to assess histological changes. At baseline, 67 patients had a mean of 36.6 sneezes/day and mean mini RQLQ score of 4.0 ± 0.7. Pre-treatment biopsies showed epithelial denudation and hyalinization of basement membrane. Following 10% silver nitrate application, 64/67 (95.5%) patients showed significant reduction in number of sneezes both at 1 week (
p
< 0.001) and 8–16 weeks (mean = 5.5 ± 7.8; p < 0.001). Post- treatment mean global mini RQLQ score was also significantly reduced (mean = 1.3 ± 1.1;
p
< 0.001). A single application was sufficient in 70.1% patients. There were no complications. Squamous metaplasia (
p
= 0.005) and epithelial hyperplasia (
p
= 0.013) as well as epithelial and basement membrane restoration occurred following therapy. 10% silver nitrate solution application is an effective and safe office- based procedure which significantly reduces sneezing improves QoL with corresponding histological changes.
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