Sinonasal Anatomic Variants in Allergic Fungal Rhinosinusitis

Abstract

Background The pathophysiology of allergic fungal rhinosinusitis (AFRS) is not well understood. Objectives To study the incidence of sinonasal anatomic variants (AVs) in AFRS. Methods Retrospective cohort study. Patients with AFRS presenting to our clinic from 2008 to 2018 were reviewed for laterality of the disease. Patients with unilateral involvement were further studied for AV presence by reviewing their preoperative sinus CT scan at original presentation. Each patient’s uninvolved side served as its own control. AVs studied include agger nasi (AN), Haller’s cells (HC), concha bullosa (CB) and supraorbital ethmoid cells (SOEC). Results A total of 155 patients with AFRS were identified. 30 patients (19.3%) had unilateral disease involvement. Of these, 16 patients had left sided and 14 patients had right sided disease. AV were present in 26 of the 30 AFRS sides (86.7%) and in 21 of the 30 healthy sides (70%), (chi squared = 2.45, p = 0.117). CB were present in 12 of 30 AFRS sides (40%) and only in 1 of 30 healthy sides (3%), (chi squared = 11.88, p = 0.0006). The presence of HC was more common in the AFRS vs healthy sides (7 of 30, 23.3% vs 2 of 30, 6.7%, respectively, p = 0.071). AN and SOEC presence was similar in both AFRS and healthy sides (p = 0.598 and p = 0.718 respectively). Conclusion AV are more common on the sides with AFRS compared to healthy sides, with the presence of CB reaching unquestionable statistical significance. Further study is needed to determine the possible association of AV, especially concha bullosa, with the pathophysiology of AFRS.

The Rate and Predictors of Allergic Fungal Rhinosinusitis Recurrence Post-sinus Surgery: A Retrospective Cohort Study

“…The specific pathogenesis of AFRS has not yet been fully understood. Nevertheless, it is unilateral in 19% of cases; however, there is no clear explanation for why AFRS tends to be unilateral [ 13 ].…”

“…These results are almost consistent with the study of Alghonaim et al [ 16 ], which reported that 29% of patients with AFRS had recurrence post-sinus surgery. Moreover, a study by Makary et al [ 13 ] reported a recurrence rate of up to 50% in patients with AFRS. In addition, a previous study published in 2017 by Marglani et al [ 17 ] included 52 patients diagnosed with AFRS.…”

“…This finding was also supported by a previous study in Karachi, Pakistan, from December 2016 to November 2018, which reported that patients with asthma are more likely to have this disease [ 18 ]. In addition, patients with concha bullosa usually develop AFRS, which means that they may be potentially associated [ 13 ].…”

The Cutting Edge of Rhinology Research

“…Hussien et al 6 establish that total immunoglobulin E, interleukin-17, and Pentraxin-3 may all serve as biomarkers for CRSwNP, as they are found in significantly higher values than in control patients, and are all associated with increased sinonasal symptoms, radiographic disease, and risk of polyp recurrence. Makary et al 7 explore the role of sinonasal anatomic variants in the pathogenesis of unilateral allergic fungal rhinosinusitis and find that a concha bullosa is significantly more likely to be found in the diseased side than in the healthy side.…”

What is appropriate management for the contralateral uninvolved side in unilateral allergic fungal rhinosinusitis?

“…Despite these treatments, recurrence rates in AFRS remain relatively high with a reported incidence as high as 79% [14][15][16][17]. Multiple studies suggest these high recurrence rates are secondary to inadequate surgical treatment [6,18]. Recent studies have evaluated the recurrence rate of uninvolved contralateral sinuses in unilateral AFRS, with some reports of eventual involvement in the previously nondiseased side.…”