What Is Allergic Fungal Sinusitis?
Allergic fungal sinusitis is a common type of infection affecting the sinus. The causative organism is the fungus that infects the sinus and causes an allergic reaction. The infecting fungi are seen in the environment, which enters the body through the air we breathe. Patients with allergic fungi cause deposition of fungal debris, causing an exaggerated amount of inflammation, and sticky mucus forms expanding sinuses. Also, the patients can have allergies and nasal polyps, and in some cases, the patients can have asthma because of this. Allergic fungal sinusitis can result in chronic sinusitis, which can affect the sense of smell. If this condition is left untreated, then it can cause displacement of the eyeball and loss of vision.
What Causes Allergic Fungal Sinusitis?
Allergic fungal sinusitis is caused by an organism called fungi. When an individual who is susceptible to this type of allergic inflammation comes in contact with these fungi through the nasal way, this will provoke an allergic inflammatory reaction in them which will lead to the formation of swelling due to fluid retention and nasal polyps. This swelling will further block the sinus, and sticky mucus accumulates, creating an environment for the fungi to grow and multiply, which will further cause more inflammation.
Allergic fungal sinusitis affects all age groups but is more seen to affect people of age between 30 to 50 years. Most of these cases go unnoticed until a complete nasal polyp is formed, which completely obstructs the nose as the condition shows slow and gradual progress of the symptoms.
What Are the Signs and Symptoms of Allergic Fungal Sinusitis?
The signs and symptoms of patients with allergic fungal sinusitis are:
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Nasal airway obstruction or difficulty in breathing through one side of the nose.
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Chronic sinusitis.
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Thick sticky drainage from the nose that is yellowish or brownish in color.
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Change in taste.
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Change in the sense of smell.
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Facial pressure or pain on only one side of the face.
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Bad breath.
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Presence of dried crusts on the lining of the nasal cavity that is brown or green in color.
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Frequent exacerbation of asthma with wheezing and chest tightness.
Patients with allergic fungal sinusitis will generally complain of a blocked nose and the formation of a semi-solid crust on the nose. Most of the time, the symptoms go unnoticed by the patients because of the gradual progression of the symptoms, and even if facial dysmorphia is present, it goes unnoticed because of the slow progression.
When the condition is left untreated, the condition can get worsened, resulting in bony expansion of the bones in the sinus and nose, which will push the eye forward, creating a striking distance between the eyes.
What Are the Complications of Allergic Fungal Sinusitis?
The complications of allergic fungal sinusitis are visual changes, cavernous sinus thrombosis (a rare life-threatening condition in which a blood clot is formed in the cavernous sinus), and expansion of the allergic mucin into the brain.
How Is Allergic Fungal Sinusitis Diagnosed?
The doctor will take the details of the symptoms and the onset of the disease, followed by a physical examination. The mucus sample will be collected and sent for further evaluation, where it is examined for fungi. The patients will also be tested for invasive fungal sinusitis, saprophytic fungal growth, mycetoma, aspergilloma, fungus ball of the sinuses, and eosinophilic mucin sinusitis to confirm if the conditions caused by allergic fungal sinusitis or not.
Imaging tests like CT (computed tomography) scan may be performed to identify the accumulated allergic fungal mucin, which is characteristic of allergic fungal sinusitis.
What Is the Treatment for Allergic Fungal Sinusitis?
After confirming the allergic fungal sinusitis by an ENT (ear, nose, and throat) specialist, the treatment is started for the condition. The aim of the treatment is to get rid of the fungi, polyps, and mucus accumulated so that the sinuses can recover and become healthy. For that, a combination of both medical therapy and surgical intervention is required. Surgery alone or medical therapy alone cannot resolve the condition completely, and there are chances for the condition to recur.
1. Medical Therapy
The medical therapy of the disease involves the use of various medicines like antifungal medications, corticosteroids, and immunotherapy which will vary from person to person and according to the severity of the disease. Also, antibiotics might be needed to treat secondary infections. The corticosteroids are used for their potent anti-inflammatory and immunomodulatory effects.
2. Surgical Therapy
Surgical therapy is done initially to remove the fungus, polyps, and mucus build-up from the sinus. The surgical therapy is done to remove the inciting fungal allergic mucin and marsupialization of the involved sinus. This will help to open up the sinus which will further allow future treatment with steroid irrigation. The surgery is done using an endoscope which consists of a camera fitted to its end to see through a screen. Due to the complex nature of allergic fungal sinusitis, it is often challenging for surgeons to operate.
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Indication for Surgical Therapy- All cases of allergic fungal sinusitis must undergo surgery of the sinuses. Also, the recurrent disease should be surgically treated.
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Contraindication for Surgery- There are no specific contraindications for patients with allergic fungal sinusitis to undergo surgery and also, normally these patients are healthy and immunocompetent.
What Is the Prognosis?
Allergic fungal sinusitis is a chronic recurrent condition. The prognosis of allergic fungal sinusitis is good when the conditions are treated completely. But there is the recurrence of the condition when there is even a slight remnant of the condition. The recurrence of the condition can be as mucosal edema, nasal polyps, scarring, allergic mucin, or fungal debris.
Conclusion
Allergic fungal sinusitis is a condition with the slow progress of the symptoms, yet important to diagnose them at the earliest to avoid complications from it. The symptoms might be similar to sinusitis and, in most cases, goes unnoticed till the nasal polyps are formed to consult a doctor. If you or your loved ones have any symptoms pertaining to sinusitis, it is always better to consult with a specialist so as to confirm the diagnosis and start the treatment if needed.
