Recurrence Pattern and Complication Rate of Allergic Fungal Sinusitis: A 10-Year Tertiary Center Experience

Abstract

Background. Allergic fungal rhinosinusitis is a noninvasive form of highly recurrent chronic rhinosinusitis. Despite the advancement in medical and surgical strategies, recurrence in AFRS in general poses another challenging problem with reported incidence that eventually can reach more than 60%. Recognition and understanding the pattern of disease recurrence will lead to greater understanding of the disease response in our population. Method. A retrospective cohort study was performed in King Abdulaziz Medical City in Riyadh, Saudi Arabia. All patients diagnosed with chronic rhinosinusitis and underwent functional endoscopic sinus surgery from the period of January 2006 to December 2016 were reviewed. Results. 28 patients were found to have AFRS based on clinical, radiological, and microscopic examination suggestive of allergic fungal rhinosinusitis. Among these patients, 53% of them were female and 46% were male. The age ranged from 13 to 55 years, with a mean age of 31.57 years. 28.57% of the patients presented with recurrent allergic fungal sinusitis. The duration between the surgery and symptoms recurrence was around one year. Male and female patients had similar recurrence rate (50%). At first visit, 95% of the patients with nonrecurrent disease presented with nasal obstruction compared to 87.5% of the patients with recurrent disease. On the other hand, patients with recurrent disease had more nasal discharge (87.5%), postnasal drip (37.5%), facial pressure/pain (50%), headache (50%), nasal polyposis (87.5%), hypertrophy of inferior turbinate (37.5%), and proptosis (12.5%). Nasal obstruction (87.5%) and nasal polyps (87.5%) were the most common presenting symptoms for the disease recurrence. The pattern of disease recurrence in the previously unilateral disease was 18% ipsilateral and 27% bilateral. For the patients who had bilateral disease formerly, 17% (n = 3) of them had recurrent bilateral disease. Conclusion. Allergic fungal rhinosinusitis is a distinct clinical entity. A high recurrence rate is a pathognomonic feature of the disease, despite all the development in medical and surgical trials. This study demonstrated that recurrence rate is lower in our population. However, more studies with a greater number of patients are needed in the future to clearly recognize the pattern of recurrence in patients with AFRS.

Allergic Fungal Rhinosinusitis in Saudi Arabia: A Review of Recent Literature

“…In contrast to worldwide studies, a female preponderance is shown in AFRS cases with a mean male percentage of 38.3%. However, the mean age was 20 years, which is concordant with international data [ 21 - 24 ]. Only two studies examined the geographical variations in prevalence.…”

“…Patients who live in old houses and overcrowded areas are more likely to develop AFRS, as AFRS is most common in patients who live in hot and humid areas such as Jeddah City [ 25 ]. Most patients had nasal polyposis diagnosed before or during ESS for CRS [ 17 , 19 , 21 - 23 ]. A history of bronchial asthma was reported in 9-36% of patients with AFRS [ 17 , 19 - 22 ].…”

“…A history of bronchial asthma was reported in 9-36% of patients with AFRS [ 17 , 19 - 22 ]. Aspirin intolerance was reported as 7.1% by Alghonaim et al [ 21 ] and 1.7% by Al-Dousary [ 19 ].…”

“…Our local data were in concordance with the international data. Most patients had nasal obstruction, nasal discharge, and headache [ 17 , 21 , 22 , 29 ]. Bilateral presentation was present in 53-69% of the patients [ 17 , 19 , 21 , 30 ].…”

Study to Determine the Incidence of Allergic Fungal Sinusitis among Patients with Nasal Polyps and Its Related Risk Factors

“…Allergic fungal sinusitis is mostly considered a disease different chronic sinusitis. It is always associated with nasal polyps [3][4] . Patients with chronic sinusitis are at a higher risk of allergic fungal sinusitis.…”