S B Kupferberg1, J P Bent. 1. Division of Otolaryngology, Medical College of Georgia, Augusta, USA.
Abstract
OBJECTIVE: To determine the optimal treatment in pediatric patients with allergic fungal sinusitis (AFS). DESIGN: A retrospective review of 10 patients diagnosed as having AFS. SETTING: Academic tertiary medical center. PATIENTS: Pediatric patients who fulfilled 5 criteria necessary for diagnosis of AFS: (1) type 1 hypersensitivity; (2) nasal polyposis; (3) characteristic computed tomographic scan; (4) histological evidence of eosinophilic mucus without evidence of fungal invasion into sinus tissue; and (5) a positive fungal stain or culture of sinus contents. TREATMENT: All patients were treated with functional endoscopic sinus surgery with removal of fungal debris. Adjuvant therapy included nasal irrigations, postoperative endoscopic cleanings, and systemic corticosteroids in 9 of 10 patients. MEAN OUTCOME MEASURE: Clinical disease monitored endoscopically by means of an objective staging system. RESULTS: Five patients were without disease (stage 0), 1 had allergic mucin and mucosal edema (stage I), 1 had allergic mucin and polypoid edema (stage II), and 3 had polyps and/or fungal debris (stage III). CONCLUSIONS: The treatment and prognosis of pediatric AFS are similar to those of adult AFS. However, systemic corticosteroids should be weaned aggressively in children to minimize complications, particularly long-term growth retardation.
OBJECTIVE: To determine the optimal treatment in pediatric patients with allergic fungal sinusitis (AFS). DESIGN: A retrospective review of 10 patients diagnosed as having AFS. SETTING: Academic tertiary medical center. PATIENTS: Pediatric patients who fulfilled 5 criteria necessary for diagnosis of AFS: (1) type 1 hypersensitivity; (2) nasal polyposis; (3) characteristic computed tomographic scan; (4) histological evidence of eosinophilic mucus without evidence of fungal invasion into sinus tissue; and (5) a positive fungal stain or culture of sinus contents. TREATMENT: All patients were treated with functional endoscopic sinus surgery with removal of fungal debris. Adjuvant therapy included nasal irrigations, postoperative endoscopic cleanings, and systemic corticosteroids in 9 of 10 patients. MEAN OUTCOME MEASURE: Clinical disease monitored endoscopically by means of an objective staging system. RESULTS: Five patients were without disease (stage 0), 1 had allergicmucin and mucosal edema (stage I), 1 had allergicmucin and polypoid edema (stage II), and 3 had polyps and/or fungal debris (stage III). CONCLUSIONS: The treatment and prognosis of pediatric AFS are similar to those of adult AFS. However, systemic corticosteroids should be weaned aggressively in children to minimize complications, particularly long-term growth retardation.