Overview
What is allergic fungal sinusitis (AFS)?
What is the role of lab testing in the diagnosis of allergic fungal sinusitis (AFS)?
What is the role of CT scanning in the diagnosis of allergic fungal sinusitis (AFS)?
What is the role of MRI in the diagnosis of allergic fungal sinusitis (AFS)?
Which histologic findings are characteristics of allergic fungal sinusitis (AFS)?
How is allergic fungal sinusitis (AFS) treated?
How has the diagnosis and treatment for allergic fungal sinusitis (AFS) evolved over time?
What are the diagnostic criteria for allergic fungal sinusitis (AFS)?
Which conditions are included in the differential diagnoses of allergic fungal sinusitis (AFS)?
What is the prevalence of allergic fungal sinusitis (AFS)?
What causes allergic fungal sinusitis (AFS)?
What is the pathophysiology of allergic fungal sinusitis (AFS)?
Which clinical history findings are characteristic of allergic fungal sinusitis (AFS)?
Which physical findings are characteristic of allergic fungal sinusitis (AFS)?
When is surgical debridement indicated for the treatment of allergic fungal sinusitis (AFS)?
Which nasal anatomy is relevant to allergic fungal sinusitis (AFS)?
Workup
What is the role of immunologic testing in the workup of allergic fungal sinusitis (AFS)?
What is the role of nonspecific allergy testing in the workup of allergic fungal sinusitis (AFS)?
What is the role of CT scanning in the workup of allergic fungal sinusitis (AFS)?
What are the sites of extension of allergic fungal sinusitis (AFS)?
What is the role of MRI in the workup of allergic fungal sinusitis (AFS)?
Which histologic findings are characteristic of allergic fungal sinusitis (AFS)?
Treatment
How is allergic fungal sinusitis (AFS) treated?
What is the role of corticosteroids in the treatment of allergic fungal sinusitis (AFS)?
What are the adverse effects of corticosteroids in the treatment of allergic fungal sinusitis (AFS)?
What is the role of immunotherapy in the treatment of allergic fungal sinusitis (AFS)?
What is the protocol for immunotherapy to treat allergic fungal sinusitis (AFS)?
What are the adverse effects of immunotherapy for allergic fungal sinusitis (AFS)?
What is the role of antifungal therapy in the treatment of allergic fungal sinusitis (AFS)?
What are the adverse effects of antifungal therapy for allergic fungal sinusitis (AFS)?
What is the role of surgery in the treatment of allergic fungal sinusitis (AFS)?
What is included in preoperative care for allergic fungal sinusitis (AFS)?
How is surgery performed for allergic fungal sinusitis (AFS)?
What is included in postoperative care following surgery for allergic fungal sinusitis (AFS)?
What is included in the long-term monitoring for allergic fungal sinusitis (AFS)?
What are the possible complications of allergic fungal sinusitis (AFS) surgery?
What is the prognosis of allergic fungal sinusitis (AFS)?
What are the controversies regarding the treatment of allergic fungal sinusitis (AFS)?
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Left middle meatus with suctioning of thick allergic mucin from the ethmoid bulla in the center of the picture; the end of the suction is in the inferior portion of the picture.
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The viscosity of a thick allergic mucin being suctioned from the nasal cavity and vestibule in a patient with allergic fungal sinusitis.
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View just inside the nasal vestibule showing diffused polyposis extending into the anterior nasal cavity and vestibule; the septum is on the right, and the right lateral vestibular wall (nasal ala) is on the left. The polyps all are in the center. The polyps almost hang out of the nasal vestibule.
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A 15-year-old boy with allergic fungal sinusitis causing right proptosis, telecanthus, and malar flattening; the position of his eyes is asymmetrical, and his nasal ala on the right is pushed inferiorly compared to the left.
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A 9-year-old girl with allergic fungal sinusitis displaying telecanthus and asymmetrical positioning of her eyes and globes.
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Coronal CT scan showing extensive allergic fungal sinusitis involving the right side with mucocele above the right orbit and expansion of the sinuses on the right.
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Typical view of a middle meatus in a patient with allergic fungal sinusitis with expansion of the ethmoid complex and extension of the middle turbinate more inferiorly. This is a postoperative view.
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Coronal CT scan showing typical unilateral appearance of allergic fungal sinusitis with hyperintense areas and inhomogeneity of the sinus opacification; the hyperintense areas appear whitish in the center of the allergic mucin.
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Coronal MRI showing expansion of the sinuses with allergic mucin and polypoid disease; the hypointense black areas in the nasal cavities are the actual fungal elements and debris. The density above the right eye is the mucocele. The fungal elements and allergic mucin in allergic fungal sinusitis always look hypointense on MRI scanning and can be mistaken for absence of disease.
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Immediate postoperative 30° angled view showing the complete removal of polyps with a widened frontal sinus recess superiorly and widened ethmoid cavity in the mid portion. The middle turbinate is on the right, pushed against the septum. The lateral nasal wall is on the left.
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Fungal ball in the right maxillary sinus.
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Fungal debris being removed from the ethmoid complex. A suction device is seen in the right lower corner of the picture.
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Allergic mucin, fungal debris, and polyps are shown after removal from the patient. The scale is in inches.
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Coronal CT scan showing the postoperative view following removal of disease after significant disease recurred on both the right and left sides of the nasal cavity and sinuses; mild mucosal thickening of all involved sinuses is present, with some moderate thickening of the left maxillary sinus. All disease, even the lateral mucocele, was removed or drained endoscopically.
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Two-week postoperative endoscopic picture showing polypoid thickening already in the ethmoid cavities while the patient was still on tapering steroids; on the left is the lateral nasal wall. The right shows the middle turbinate next to the septum.
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A polypoid recurrence in the center of the ethmoid cavity. The septum is on the left.