Treatment of Allergic Fungal Sinusitis
The Role Sinus Surgery, Nasal Spray, Sinus Rinse and Immunotherapy
Oct 1, 2009
Allergic fungal sinusitis, a condition caused by sinus allergy to fungal elements in the environment, causes symptoms that can mimic allergic rhinitis or chronic sinusitis symptoms. The treatment for allergic fungal sinusitis is mainly endoscopic sinus surgery followed by other measures for sinus pressure relief like nasal spray, nasal irrigation or sinus rinse and immunotherapy.
Endoscopic Sinus Surgery for Allergic Fungal Sinusitis
Functional endoscopic sinus surgery is currently the treatment of choice for allergic fungal sinusitis.
The goals of surgery include :
- Debridement - complete removal of fungal debris, allergic mucin and polyps filling the sinuses
- Ventilation - opening up the sinuses so they are well-aerated, since dark, moist nooks without good ventilation promote fungal growth and can lead to recurrences
- Correction of certain anatomical conditions like a deviated nasal septum, concha bullosa (condition where the usually bony middle turbinate is air-filled like a sinus) and others that facilitate chronic sinusitis pathology
Endoscopic sinus surgery makes use of rigid endoscopes with a camera attached to give a better and magnified view of the inside of the nasal cavity. Conventional instruments or a microdebrider may be used to achieve the goals of surgery.
Corticosteroid Nasal Sprays for Sinus Allergy
One of underlying factors in the mechanism of allergic fungal sinusitis is chronic inflammation, hence the use of corticosteroids which are potent anti-inflammatory drugs. Oral corticosteroids can cause many deleterious side effects so their use is limited to short courses, often preoperatively to shrink the polyps which are frequent with allergic fungal sinusitis.
The better idea is to use corticosteroids topically in spray form which ensures drug delivery to the targeted tissue (the nasal tissue and the sinuses) in the optimal aerosol form. This method also minimizes adverse effects of the drug as its absorption from the nasal mucosa into the blood stream is negligible.
Topical corticosteroid nasal sprays are recommended post-operatively. The anti-inflammatory effect of the drug goes a long way in preventing a relapse of allergic fungal sinusitis.
Nasal or Sinus Irrigation for Sinus Allergy
Nasal irrigation or nasal douching with saline is also advised post-operatively. This helps keep the nasal cavity clean from crusting which occurs after surgery. It also helps prevent formation of adhesions which can block the nose.
Role of Antifungal Drugs
Antifungal drugs are known for their toxic side effects and are reserved for the severe and invasive forms of fungal sinusitis. Allergic fungal sinusitis usually does not require the use of antifungal agents as there is no invasion of the sinus tissue by the fungal elements in this condition.
Immunotherapy for Fungal Sinus Allergy
Immunotherapy consists of exposing an atopic person to gradually increasing strengths of allergens in a bid to cause desensitization and avoid an allergic response. It is a method that has found a high rate of success in the treatment of various allergic conditions including allergic fungal sinusitis. But it works best only after surgery; that is, after the complete removal of the inciting fungal elements in the sinuses.
Long term follow up is usually advised. Periodic check-ups, nasal endoscopy and debridement help prevent a recurrence of this condition.
Sources:
Gleeson, Michael J. "Scott-Brown's Otorhinolaryngology: Head and Neck Surgery" (Oxford University Press; 7 Edition, 2008)
 |
