Rhinitis caseosa, nasal cholesteatoma and allergic fungal sinusitis.

Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, 110 029 New Delhi, India.
Indian Journal of Otolaryngology and Head & Neck Surgery (Impact Factor: 0.05). 03/2003; 55(1):14-20. DOI: 10.1007/BF02968746
Source: PubMed

ABSTRACT The recently described Syndrome of Allergic Fungal Sinusitis (AFS) has many similarities with the previously described entity of rhinitis Caseosa (synonym-Nasal Cholesteatoma). 28 patients treated over a 6 year period with a diagnosis of rhinitis caseosa/nasal cholesieatoma have been retrospectively reviewed with regard to their clinical and radiological features, operative findings and microbiologic and histopathologual features.All cases presented with nasal obstruction and nasal polyposis. CT scanning indicated intracranil extension and intra-orbital extension m 9 cases each. Surgical debridetnent with establishment of sinus drainage led to the universal initial relief of symptoms in all cases. 26 of 28 cases have remained free of recurrence on prolonged follow-up (minimum follow-up one year).Despite these cases demonstrating clinical, radiologital, morphological and histological similarities with the Syndrome of Allergic Fungal Sinustitis, in only 2 cases was a fungal aetiology confirmed by history. The clinical syndrome of "Rhinitis Caseosa" is described and its relationship with the Allergic Fungal Sinusitis (AFS) syndrome and the "AFS-hke" Syndrome explored.

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    ABSTRACT: Allergic fungal sinusitis (AFS) is a noninvasive disease first described as a distinctive clinical and histopathologic entity more than 10 years ago. The typical patient is immunocompetent, atopic, has chronic sinusitis refractory to medical therapy, and 100% of those we have diagnosed have nasal polyps. Because of the histopathologic similarity to mucoid impaction of the bronchi seen in allergic bronchopulmonary aspergillosis, Aspergillus species were initially suspected as the causative agent. Subsequent reports include a number of non-Aspergillus-related cases. Both we and others have found a 7% incidence of AFS among chronic sinusitis patients requiring surgery. Relapse after surgical debridement and aeration is common and often responds to systemic corticosteroids. The diagnosis of AFS should be considered in all atopic patients with nasal polyps and chronic sinusitis. The clinical and histopathologic features of this disorder are reviewed.
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