Objective
To determine the optimal treatment in pediatric patients with allergic fungal sinusitis (AFS).
Design
A retrospective review of 10 patients diagnosed as having AFS.
Setting
Academic tertiary medical center.
Patients
Pediatric patients who fulfilled 5 criteria necessary for diagnosis of AFS: (1) type 1 hypersensitivity; (2) nasal polyposis; (3) characteristic computed tomographic scan; (4) histological evidence of eosinophilic mucus without evidence of fungal invasion into sinus tissue; and (5) a positive fungal stain or culture of sinus contents.
Treatment
All patients were treated with functional endoscopic sinus surgery with removal of fungal debris. Adjuvant therapy included nasal irrigations, postoperative endoscopic cleanings, and systemic corticosteroids in 9 of 10 patients.
Mean Outcome Measure
Clinical disease monitored endoscopically by means of an objective staging system.
Results
Five patients were without disease (stage 0), 1 had allergic mucin and mucosal edema (stage I), 1 had allergic mucin and polypoid edema (stage II), and 3 had polyps and/or fungal debris (stage III).
Conclusions
The treatment and prognosis of pediatric AFS are similar to those of adult AFS. However, systemic corticosteroids should be weaned aggressively in children to minimize complications, particularly long-term growth retardation.
Arch Otolaryngol Head Neck Surg. 1996;122:1381-1384
