Clinical Evaluation of Effectiveness of Itraconazole in Preoperative and Refractory Postoperative Patients of Allergic Fungal Sinusitis

Abstract

BACKGROUND Allergic Fungal Sinusitis (AFS) is a noninvasive type of fungal sinusitis, clinically and pathologically a unique entity of chronic rhinosinusitis. The aetiology, pathogenesis, and treatment of AFS are subject to controversy. In spite of aggressive endoscopic surgery, pre-and postoperative steroids and immunotherapy recurrence rates are high. Many additions are made to its original description and management since its early description in 1980. The aim of the present paper was to evaluate clinically. The response to high-dose itraconazole before endoscopic sinus surgery and in refractory postoperative patients. Related literature was reviewed in the light of the present study. MATERIALS AND METHODS A 2 year prospective study conducted on 68 AFS patients divided into two groups to clinically evaluate the results after using oral itraconazole preoperatively in one group and in refractory postoperative period in another. RESULTS The mean age of patients with typical AFS was 36±3.9 years. Patients with AFS with an average follow up of 21 months were included. Recurrence was 6/34 (17.64%) in itraconazole group and revision FESS done in 3/34 (08.82%). Recurrence in patients without itraconazole was 16/34 (47.05%) and refractory to conventional treatment, but responded to itraconazole in 14/16 (87.50%). Revision surgery required in 2/16 (12.50%) after starting oral itraconazole. No side effects or reactions were observed in a total of 7920 doses administered. CONCLUSION Itraconazole is well tolerated by patients and effective in shrinking the polyposis preoperatively with low recurrence. Postoperative refractory AFS is amenable in (87.50%) of patients avoiding repeat FESS. Overall, low recurrence rate and minimizing revision surgery when compared to patients treated without itraconazole was evident in the study.