BACKGROUND:Nasal polyposis is a common problem in the eastern province of Saudi Arabia. Since allergic fungal sinusitis (AFS) can present with unilateral or bilateral nasal polyps, it is important to be aware of the prevalence of AFS in patients with nasal polyps.PATIENTS AND METHODS:The medical records of 91 patients with nasal polyps admitted for functional endoscopic sinus surgery were reviewed. The diagnosis of AFS was considered if histopathology showed the presence of eosinophillic mucin-containing hyphae. The following data were collected: presence of associated asthma, IgE levels, grading of CT scan findings, and operative details.RESULTS:Histopathological diagnosis was positive for AFS in 11 of 91 patients 12.1%. There was a highly significant statistical difference in IgE levels between patients suffering AFS and chronic hyperplastic rhinosinusitis with nasal polyps (P<.0001). The overall incidence of recurrence of polypi was 50.5% (45 of 89 patients who had follow up for a minimum of one year) and the rate of recurrence in patients with AFS was 54.5% (6 of 11 patients with AFS). There was a significant direct relationship between the CT grading of nasal polyps and recurrence, with a recurrence rate of 60.7% (34 of 56) in patients with grade III nasal polyps.CONCLUSION:This study showed that the prevalence of AFS among patients with nasal polyps is 12.1%, and suggests that CT grading of nasal polyps can be used as a prognostic factor for disease recurrence.

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Reports in rhinology suggest that operated cases of chronic hypertrophic rhinitis with nasal polyps are more prone to further recurrence. This study was designed to find out if recurrence rate after surgery is related to a possible increase in the incidence and degree of osteitis. A prospective study of 82 patients with nasal polyps was carried out. They were divided into two groups: group A 50 patients, undergoing FESS for the first time, group B 32 patients, undergoing revision surgery. Histopathological examination was performed for specimens taken from the bony septa of the ethmoid with the overlying mucosa. Bony changes were seen in only 30% of the patients in group A, compared to 87.5% in group B; this difference was statistically highly significant (p = 0.001). Failure was seen in five patients (10%) in group A, 26.6% had osteitis. In contrast, failure was seen in 53% of group B, and constituted 60.7% of patients with osteitis in this group. Surgery plays a major role in increasing the incidence of osteitis in patients with nasal polyps. The increase recurrence rate in revision cases is not only related to osteitis. There are other factors than osteitis which needs further studies.

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