Skip to main content
Log in

Management of allergic fungal sinusitis with intracranial spread

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Allergic fungal sinusitis (AFS) is a form of paranasal nasal disease if not managed early often involves bone destruction and extension into the orbit and anterior skull base. We present our study of patients with AFS with intracranial, exdradural extension. This study includes our experience of 26 patients with the histological and immunological diagnosis of AFS based on findings of branching septate fungi interspersed with eosinophilic mucin and Charcot-Leyden crystals without fungal invasion of soft tissue, with intracranial extension. All had erosion of bone, which was observed on computerized tomography (CT) scans, extending intracranially and eight had disease that additionally involved the lamina papyracea. The average age of patients in this study was 25 years (range 9–46). There were 20 male and 6 female patients. All patients were immunocompetent. Skin test against aspergillin showed all patients had Type 1 hypersensitivity. All patients underwent transnasal and/or transmaxillary endoscopic approaches for debridement and eight underwent orbital decompression. No patient underwent craniotomy for removal of intracranial extradural disease. No patient had a cerebrospinal fluid leak. Postoperatively, all 26 were treated with a course of corticosteroids. The follow-up period ranged from 2 to 5 years. We conclude AFS is a unique form of fungal disease that might mimic anterior skull base and paranasal sinus tumors. Most cases can be successfully managed with transnasal and/or transmaxillary endoscopic techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Millar JW, Johnston A, Lamb D (1981) Allergic aspergillosis of the maxillary sinuses. Thorax 36:710

    Google Scholar 

  2. Katzenstein AL, Sale SR, Greenberger PA (1983) Allergic Aspergillus sinusitis. J Allergy Clin Immunol 72:89–93

    Article  PubMed  CAS  Google Scholar 

  3. Klapper SR, Lee AG, Patrinely JR, Stewart M, Alford EL (1997) Orbital involvement in allergic fungal sinusitis. Ophthalmology 104:2094–2100

    PubMed  CAS  Google Scholar 

  4. Manning SC, Holman M (1998) Further evidence of the allergic pathophysiology in allergic fungal sinusitis. Laryngscope 108:1485–1496

    Article  CAS  Google Scholar 

  5. Kupferberg SB, Bent JP III, Ferreiro JA, Roberts GD (1997) Prognosis for allergic fungal sinusitis. Otolayrngol-Head Neck Surg 117:35–41

    Article  CAS  Google Scholar 

  6. Cody DT 2nd, Neel HB 3rd, Ferreiro JA, Roberts GD (1994) Allergic fungal sinusitis: the Mayo clinic experience. Laryngoscope 104:1074–1079

    Article  PubMed  Google Scholar 

  7. Schubert MS (2004) Allergic fungal sinusitis. Otolaryngol Clin N Am 37:301–326

    Article  Google Scholar 

  8. Manning SWC, Mabry RL, Schaefer SD et al (1993) Evidence of IgE mediated hypersensitivity in allergic fungal sinusitis. Laryngoscope 103:717–721

    Article  PubMed  CAS  Google Scholar 

  9. Kuhn FA, Javer AR (2000) Allergic fungal sinusitis, a four year follow-up. Am J Rhinol 14:149–56

    Article  PubMed  CAS  Google Scholar 

  10. Katzenstein AL, Sale SR, Greenberger PA (1983) Pathologic findings in allergic Aspergillus sinusitis. A newly recognized form of sinusitis. Am J Surg Pathol 7:439–443

    Article  PubMed  CAS  Google Scholar 

  11. Carter KD, Graham SM, Carpenter KM (1999) Ophthalmic manifestations of allergic fungal sinusitis. Am J Ophthalmol 127:189–195

    Article  PubMed  CAS  Google Scholar 

  12. Houser SM, Corey JP (2000) Allergic fungal rhinosinusitis: pathophysiology, epidemiology, and diagnosis. Otolaryngol Clin N Am 33:399–409

    CAS  Google Scholar 

  13. Corey JP (1992) Allergic fungal sinusitis. Otolaryngol Clin N Am 25:225–230

    CAS  Google Scholar 

  14. Ferguson BJ (2000) Eosinophilic mucin rhinosinusitis: a distinct clinico- pathological entity. Laryngoscope 110:799–813

    Article  PubMed  CAS  Google Scholar 

  15. Kupferberg SB, Bent JP (1996) Allergic fungal sinusitis in the pediatric population. Arch Otolaryngol Head Neck Surg 122:1381–1384

    PubMed  CAS  Google Scholar 

  16. Marple BF (2001) Allergic fungal rhinosinusitis: current theories and management strategies. Laryngoscope 111:1006–1019

    Article  PubMed  CAS  Google Scholar 

  17. Lydiatt WM, Sobba-Higley A, Huerter N Jr et al (1994) Allergic fungal sinusitis with intracranial extension and frontal lobe symptoms: a case report. Ear Nose Throat J 73:402–404

    PubMed  CAS  Google Scholar 

  18. Daghistani KJ, Jamal TS, Zaher TS, Zaher S et al (1992) Allergic Aspergillus sinusitis with proptosis. J Laryngol Otol 106:799–803

    Article  PubMed  CAS  Google Scholar 

  19. Kinsella JB, Rassekh CH, Bradfield JL et al (1996) Allergic fungal sinusitis with cranial base erosion. Head Neck 18:211–217

    Article  PubMed  CAS  Google Scholar 

  20. Marple BF (2000) Allergic fungal rhinosinusitis: surgical management. Otolaryngol Clin N Am 33:409–419

    Article  CAS  Google Scholar 

  21. Rupa V, Jacob M, Mathews MS (2001) Atopy, proptosis, and nasal polyposis. Allergic fungal sinusitis with proptosis. Postgrad Med J 77:343 350–352

    Article  PubMed  CAS  Google Scholar 

  22. deShazo RD, Swain RE (1995) Diagnostic criteria for allergic fungal sinusitis. J Allergy Clin Immunol 96:24–35

    Article  PubMed  CAS  Google Scholar 

  23. Loury MC, Leopold DA, Schaefer SD (1993) Allergic Aspergillus sinusitis. Arch Otolaryngol Head Neck Surg 119:1042–1043

    PubMed  CAS  Google Scholar 

  24. Manning SC, Schaefer SD, Close LG et al (1991) Culture-positive allergic fungal sinusitis. Arch Otolaryngol Head Neck Surg 117:174–178

    PubMed  CAS  Google Scholar 

  25. Ferguson BJ, Bames L, Bemstein JM et al (2000) Geographic variation in allergic fungal rhinosinusitis. Otolaryngol Clin N Am 33:441–449

    CAS  Google Scholar 

  26. Mukherji SK, Figueroa RE, Ginsberg LE et al (1998) Allergic fungal sinusitis: CT findings. Radiology 207:417–422

    PubMed  CAS  Google Scholar 

  27. Manning SC, Vuitch F, Weinberg AG, et al (1989) Allergic aspergillosis: a newly recognized form of sinusitis in the pediatric population. Laryngoscope 99:681–685

    Article  PubMed  CAS  Google Scholar 

  28. Robson JM, Hogan PG, Benn RA et al (1989) Allergic fungal sinusitis presenting as a paranasal sinus tumour. Aust NZ J Med 19:351–353

    CAS  Google Scholar 

  29. Morpeth JF, Rupp NT, Dolen WK et al (1996) Fungal sinusitis: an update. Ann Allergy Asthma Immunol 76:128–140

    Article  PubMed  CAS  Google Scholar 

  30. deShazo RD, Chapin K, Swain RE (1997) Fungal sinusitis. N Engl J Med 337:254–259

    Article  PubMed  CAS  Google Scholar 

  31. Hamilos DL (2000) Chronic sinusitis. J Allergy Clin Immunol 106:213–227

    Article  PubMed  CAS  Google Scholar 

  32. Kuhn FA, Javer AR (2000) Allergic fungal rhinosinusitis: perioperative management, prevention of recurrence, and role of steroids and antifungal agents. Otolaryngol Clin North Am 33:419–433

    PubMed  CAS  Google Scholar 

  33. Mabry RL, Mabry CS (2000) Allergic fungal sinusitis: the role of immunotherapy. Otolaryngol Clin N Am 33:433–440

    CAS  Google Scholar 

  34. Mabry RL, Marple BF, Mabry CS (2000) Outcomes after discontinuing immunotherapy for allergic fungal sinusitis. Otolaryngol Head Neck Surg 122:104–106

    Article  PubMed  CAS  Google Scholar 

  35. Liu J K, Schaeffer SD (2004) Neurosurgical implications of allergic fungal sinusitis. J Neurosurg 100:883–890

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shabbir Akhtar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ikram, M., Akhtar, S., Ghaffar, S. et al. Management of allergic fungal sinusitis with intracranial spread. Eur Arch Otorhinolaryngol 265, 179–184 (2008). https://doi.org/10.1007/s00405-007-0430-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-007-0430-x

Keywords

Navigation