Pediatric Allergic Fungal Rhinosinusitis: Does Age Make a Difference?

Abstract

BackgroundAllergic fungal rhinosinusitis (AFRS) is a hypersensitive response to fungi within the sinus cavity. Children represent a challenging group of patients with sinonasal disorders, as their sinus anatomy is not fully developed. This study aimed to determine the various clinical manifestations and management outcomes in children with AFRS. MethodsA retrospective chart review of children who underwent sinus surgery for AFRS at a tertiary healthcare center between 2005 and 2021 was performed. Demographics, clinical manifestations, radiological and laboratory results, treatment regimens, complications, and recurrence rates were collected. Subanalysis was performed based on age at first surgery: group A (<13 years) and group B (≥13 years). ResultsOverall, 35 children underwent sinus surgery for AFRS during the study period. The mean patient age at the time of surgery was 14 years. Bilaterality was present in 15/35 (42.9%) patients and anosmia in 12/35 (34.3%). Polyps on examination were present in 31/35 (88.6%) patients and proptosis in 8/35 (22.9%). Subanalysis revealed that group A showed less bilateral disease (11.4%) than group B (31.4%) and a lower Lund-Mackay score (median=11.50 and 17, respectively, p=0.002). ConclusionAge at surgery did not have an impact on the outcome. A high index of suspicion should be exercised when dealing with children with sinonasal symptoms that do not respond to routine treatment and should be investigated for chronic sinusitis.

Allergic Fungal Rhinosinusitis in a 12-Year-Old Male Resulting in the Remodeling of Cribriform Plate With Protrusion Into the Anterior Cranial Fossa: A Case Report

“…AFRS most commonly presents with nasal obstruction, nasal discharge and rhinorrhea, anosmia, and headaches. In the pediatric population, a much larger proportion of patients tend to present with facial skeletal abnormalities, osseous involvement, and ocular manifestations, such as proptosis [ 2 ]. One study found that 25% of pediatric patients diagnosed with AFRS presented with proptosis, while another found that closer to 50% of pediatric patients diagnosed with AFRS presented with such symptoms when compared to adult patients with the same diagnosis [ 2 , 3 ].…”

“…Some studies found pediatric disease relapse rates of around 55% at the one-year follow-up in patients who received endoscopic sinus surgery followed by nasal irrigation, endoscopic cleanings, and systemic steroid therapy [ 3 ]. Without postoperative adjuvant therapy, recurrence rates can be as high as 100% [ 2 ].…”

“…AFRS often manifests clinically as nasal discharge, nasal obstruction, nasal polyps, anosmia, and headaches. However, in pediatric patients, AFRS often presents with facial and ocular symptoms such as sinus pain and proptosis [ 2 ]. CRS in the pediatric population is associated with a multitude of diverse etiologies, which help guide the course of treatment.…”

Allergic Fungal Rhinosinusitis in Europe: Literature Review and Own Experience

“…According to EPOS 2020 [1], postoperative systemic corticosteroids improve short-term outcomes in AFRS and are likely to reduce long-term recurrence. Nasal and oral steroid therapy, oral and topical antifungal drugs (itraconazole, fluconazole), rinsing the nose with saline solution, immunotherapy, antihistamines, and antibiotic therapy are also used in the treatment process [25][26][27]. While using intranasal steroid, nebulized intranasal steroid is better than simple nasal steroid sprays.…”