Diseases of PNS
All of the following are diagnostic criteria of allergic Fungal sinusitis (AFS) except: [AIIMS May 2010]
|A||Areas of High attuenuation on CT scan|
|C||Allergic eosinophilic mucin|
|D||Type 1 Hypersitivity|
Ref. Current Diagnosis and Treatment in Otorhinology 2nd/ed p 276; Scott Brown 7th/ed Vol 2 pp 7452-7454;
Ear Nose and Throat Histopathology 2nd/ed p 752; Patterson's Allergic Disease 6th/ed p 778; Allergy and Immunology:
An Otolaryngic Approach (200 7 )/239 /
Allergic fungal sinusitis is a noninvasive form of fungal sinusitis as such orbital invasion is not its feature.
Bent and Kuhn Criteria for Allergic Fungal Sinusitis (AFS)
CT scan findings in AFS
1. Type I hypersensitivity (confirmed by history, skin test or serology most important criteria)
2. Nasal polyposis
4. Unilateral predominance
5. Eosinophilic mucus demonstrating fungal elements, charcot-Ieyden crystal
6. Peripheral eosinophilia
7. Positive fungal culture
8. Charachteristic Radiological Findings (CT, MRI) absence of tissue invasion by fungus
9. Radiographic bone erosion
Areas of High attenuation surrounded by a thin zone of low attenuation
CT scan reveals pansinusitis and polyposis
Allergic Fungal Sinusitis (AFS): Form of Chronic Sinusitis
a. AFS in a unique type of noninvasive sinusitis caused by Type I or Type III hypersensitivity reactionQ to fungal organisms that
• come in contact with the nasal sinus mucosa.
b. It is seen in an immunocompetent host? with allergy to fungus.
c. IgE levels are high in patients of AFS
d. It is mostly caused by dermatiaceous specles? (Bipolaris, cunicularia, altern aria) and rarely by aspergilus.
e. M/C in younger age grp (z 30 years)
f. Clinically patients present with Nasal polyposis which can be U/L or BIL (U/L > B/L).
g. The classic rhinoscopic finding in AFS is thick, tenacious peanut butter like inspissated mucus in one or more paranasal sinuses.
h. Histological examination of this 'allergic mucin' reveals: - Embedded eostnophlls?
- Charcot-Leyden crystal SO (eosinophil breakdown products).
- Extramucosal fungal hyphae? (without tissue invasion).
• Eosinophilis are increased in blood
• X-ray shows-bony extension
• On CT scan ~ Sinus opacites with extension seen
• Treatment consists of removal of all mucin along with either topical or systemic antifungals. Prednisone is also given along with it.
• Immunotherapy is being tried for its treatment.
• Recurrence is common
Stage Endoscopic finding
Stage 0 No mucosal edema or allergic mucin
Stage 1 Mucosal edema with or without allergic mucin Stage 2 Polypoid oedema withlwithout allergic mucin Stage 3 Sinus polyps with fungal debris or allergic mucin.