Sinonasal polyposis and fungus: a growing relationship

To determine the frequency of underlying fungus in nose and paranasal sinuses in patients present with nasal polyposis. A total of 324 patients presented with nasal polyps were included in this study. Data collected from all the patients admitted in ENT department with diagnosis of nasal polyposis. All the relevant information about their presenting symptoms was recorded in a proforma. Post operatively the removed material was sent for histopathology and fungal culture. Later the findings of biopsy and culture reports were also recorded and analysed. Out of 324 patients 159 were males and 165 were females. Underlying fungus was present in 226[69.75%] and out of them, 102[45.13%] were males and 124[54.86%] were females with a P value of 0.039. The mean age was 25.95 +/- 9.32 [15-45] years for the patient with fungus. Aspergillus was the commonest organism found. Underlying fungus was found in a significantly high number of patients presented with nasal polyps and Aspergillus was the commonest organism found

Presentation and management of allergic fungal sinusitis

To assess the presentation of allergic fungal sinusitis and describe the line of management in our setup. Descriptive study. Study was conducted in Otorhinolaryngology Department, Dow Medical College and Civil Hospital, Karachi, from January 2004 to January 2005. Culture and sensitivity / fungal stain proven 20 cases of allergic fungal sinusitis were selected for the study, irrespective of age and gender. Data including age, gender, socioeconomic status, signs, symptoms, laboratory findings [especially Immunoglobulin E and eosinophil count] and imaging studies [Computed Tomography and /or Magnetic Resonance Imaging] were noted for the study. Pre and postoperative medical treatment, surgery performed, follow-up; residual/recurrence disease and revised surgery performed were also recorded. In this series, allergic fungal sinusitis was a disease of younger age group with an average age of 20.75 years with male dominance [70%]. Poor socioeconomic status [80%], allergic rhinitis [100%] and nasal polyposis [100%] were important associated factors. Nasal obstruction [100%], nasal discharge [90%], postnasal drip [90%] and unilateral nasal and paranasal sinuses involvement [60%] were the commonest presenting features. Aspergillus [60%] was the most common etiological agent. In all cases [100%], increased eosinophil count and IgE levels were present. Orbital [20%] and intracranial [10%] involvement were also seen. Surgical management was preferred in all cases. Functional endoscopic sinus surgery in 90% cases and lateral rhinotomy in 10% cases were performed. Recurrence / residual disease was seen in 20% cases. In this series, allergic fungal sinusitis was seen in immunocompetent, young males, belonging to poor socioeconomic status, suffering from allergic rhinitis and nasal polyposis, presenting with nasal obstruction, nasal discharge and postnasal drip. Functional endoscopic sinus surgery was the most important problem solving procedure while lateral rhinotomy was reserved for extensive disease