A Sticky Situation: Contemporary Management of Allergic Fungal Sinusitis (2022 AMW)
2022 AAO-HNSF Annual Meeting & OTO Experience
Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis with nasal polyposis (CRSwNP) associated with type 2 driven IgE-mediated hypersensitivity and clinically characterized by extensive bony erosion and thick, sticky eosinophilic mucin. AFRS occurs in healthy patients often residing in warm humid climates such as the Southern United States. It not only affects quality of life but can also be locally destructive leading to proptosis, epiphora, and cranial neuropathy. Imaging often shows erosion of the skull base or orbital walls, leading to a misdiagnosis of tumor. Because of these unique features, management of AFRS can be far more complex than that of typical CRSwNP. Treatment commonly includes surgical management, which is often complex due to loss of bony landmarks and severe distortion of anatomy. Due to the tenacious mucin and over-expression of the innate immune system, this disease process often recurs. This panel will use case-based discussions to educate the audience with special emphasis on how it differs from typical CRSwNP. We will cover etiology, appropriate workup, medical options including biologics, surgical considerations of AFRS, and special circumstances such as management of pediatric patients.
Credits
CME:1.0, MOC:1.0