Skip to main content
SpringerLink
Log in

The Evaluation of the Sensitivity and Specificity of a New Endoscopic Diagnostic Sign of Allergic Fungal Rhinosinusitis: Intrapolypoidal White Particles

Journal of Maxillofacial and Oral Surgery volume 20, pages 612–618 (2021)Cite this article

Abstract

Purpose

The diagnostic criteria of allergic fungal rhinosinusitis focus on characteristic clinical, radiographic, histopathologic findings and immunologic characteristics of the disease. None of these are useful for a prompt outpatient diagnosis of the condition. No clear endoscopic signs (pathognomonic) of polyps in allergic fungal rhinosinusitis are mentioned in the literature.

Objective

The objective of this study is to describe and evaluate the sensitivity and specificity of an endoscopic sign the intrapolypoidal white particles for the diagnosis of allergic fungal rhinosinusitis in outpatient setting.

Methodology

In a descriptive, cross-sectional study, 46 chronic rhinosinusitis patients were examined by endoscope in the outpatient clinic. The endoscopic images of the nasal polypi were captured preoperatively. During endoscopic surgery, a sample of nasal polypi was taken for fungal staining and culture. Results of histopathology were compared to the impression of rhinologist on the images of nasal polypi captured preoperatively.

Results

The most common endoscopic features were the expansion of sinus (24, 52.2%) and intrapolypoidal white particles (50%). Intrapolypoidal white particles were calculated to have 85.71% sensitivity, 65.63% specificity, 52.17% positive predictive value, 91.3% negative predictive value and 71.74% diagnostic accuracy.

Conclusion

This study offers a new endoscopic sign, intrapolypoidal white particles for diagnosing allergic fungal rhinosinusitis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2
Fig. 3

References

  1. Hoyt AE, Borish L, Gurrola J, Payne S (2016) Allergic fungal rhinosinusitis. J Allergy Clin Immunol Pract 4:599–604. https://doi.org/10.1016/j.jaip.2016.03.010

    Article  PubMed  Google Scholar 

  2. Brescia G, Franz L, Alessandrini L, Parrino D, Barion U, Marioni G (2019) Prognostic role of blood eosinophil and basophil levels in allergic fungal rhinosinusitis (AFRS). Am J Otolaryngol 41(1):102301. https://doi.org/10.1016/j.amjoto.2019.102301(in press)

    Article  PubMed  Google Scholar 

  3. Dykewicz MS, Rodrigues JM, Slavin RG (2018) Allergic fungal rhinosinusitis. J Allergy Clin Immunol 142:341–351. https://doi.org/10.1016/j.jaci.2018.06.023

    Article  PubMed  Google Scholar 

  4. Rai G, Das S, Ansari MA, Singh PK, Gupta N, Sharma S et al (2018) Phenotypic and functional profile of Th17 and Treg cells in allergic fungal sinusitis. Int Immunopharmacol 57:55–61. https://doi.org/10.1016/j.intimp.2018.02.009

    Article  CAS  PubMed  Google Scholar 

  5. Singh V (2019) Fungal rhinosinusitis: unravelling the disease spectrum. J Maxillofac Oral Surg 18:164–179. https://doi.org/10.1007/s12663-018-01182-w

    Article  PubMed  PubMed Central  Google Scholar 

  6. Marple BF (2001) Allergic fungal rhinosinusitis: current theories and management strategies. Laryngoscope 111(6):1006–1019

    Article  CAS  Google Scholar 

  7. Azar S, Mansour B, Parivash K, Babak B (2011) Fungal rhinosinusitis in hospitalized patients in Khorramabad, Iran. MEJSR 7:387–391

    Google Scholar 

  8. Glass D, Amedee RG (2011) Allergic fungal rhinosinusitis: a review. Ochsner J 11:271–275

    PubMed  PubMed Central  Google Scholar 

  9. Khan A, Farman A, Din S, Khan N, Dawar A (2011) Frequency of allergic fungal chronic rhinosinusitis. Pak J Otolaryngol 27:12–14

    Google Scholar 

  10. Kamal MS, Ahmed KU, Humayun P, Atiq T, Hossain A, Rasel MA (2011) Association between allergic rhinitis and sino-nasal polyposis. Bangladesh J Otorhinolaryngol 17:117–120

    Article  Google Scholar 

  11. Marcus S, Roland LT, DelGaudio JM, Wise SK (2018) The relationship between allergy and chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 4(1):13–17. https://doi.org/10.1002/lio2.236

    Article  PubMed  PubMed Central  Google Scholar 

  12. Manning SC, Merkel M, Kriesel K, Vuitch F, Marple B (1997) Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis. Laryngoscope 107:170–176

    Article  CAS  Google Scholar 

  13. Banerji A, Piccirillo JF, Thawley SE, Levitt RG, Schechtman KB, Kramper MA et al (2007) Chronic rhinosinusitis patients with polyps or polypoid mucosa have a greater burden of illness. Am J Rhinol 21:19–26

    Article  Google Scholar 

  14. Fandino M, Macdonald KI, Lee J, Witterick IJ (2013) The use of postoperative topical corticosteroids in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis. Am J Rhinol Allergy 27:e146–e157

    Article  Google Scholar 

  15. Bent JP, Kuhn FA (1994) Diagnosis of allergic fungal sinusitis. Otolaryngology–head and neck surgery. Otolaryngol Head Neck Surg 111:580–588

    Article  Google Scholar 

  16. de Shazo RD, O’Brien M, Chapin K, Soto-Aguilar M, Gardner L, Swain R (1997) A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 123:1181–1188

    Article  CAS  Google Scholar 

  17. Cody DT, Neel HB, Ferreiro JA, Roberts GD (1994) Allergic fungal sinusitis: the Mayo Clinic experience. Laryngoscope 104:1074–1079

    Article  Google Scholar 

  18. Ponikau JU, Sherris DA, Kern EB, Homburger HA, Frigas E, Gaffey TA et al (1999) The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 74:877–884

    Article  CAS  Google Scholar 

  19. Dhiwakar M, Thakar A, Bahadur S, Sarkar C, Banerji U, Handa KK et al (2003) Preoperative diagnosis of allergic fungal sinusitis. Laryngoscope 113:688–694

    Article  Google Scholar 

  20. Wise SK, Rogers GA, Ghegan MD et al (2009) Radiologic staging system for allergic fungal rhinosinusitis (AFRS). Otolaryngol Head Neck Surg 140:735–740

    Article  Google Scholar 

  21. Dutre T, Al Dousary S, Zhang N, Bachert C (2013) Allergic fungal rhinosinusitis-more than a fungal disease? J Allergy Clin Immunol 132(2):4879.e1. https://doi.org/10.1016/j.jaci.2013.02.040

    Article  Google Scholar 

  22. Marple BF (2006) Allergic fungal rhinosinusitis: a review of clinical manifestations and current treatment strategies. Med Mycol 44(Supplementary 1):S277–S284. https://doi.org/10.1080/13693780600778650

    Article  PubMed  Google Scholar 

  23. Ashour TA, Ashour R (2014) Prevalence of allergic fungal sinusitis in refractory chronic rhinosinusitis in Saudi Arabia. PAJR 4:57

    Google Scholar 

  24. Al-Dousary SH (2008) Allergic fungal sinusitis: radiological and microbiological features of 59 cases. Ann Saudi Med 28:17–21

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

None

Author information

Authors and Affiliations

  1. Deparment of Otolaryngology-Head and Neck Surgery, College of Medicine, King Abdul Aziz University Hospital, King Saud University, PO Box No-245, Riyadh, 11411, Kingdom of Saudi Arabia

    Khalid Al-Qahtani, Fahad Nasser Altamimi & Nouf Abdulkalq Al-Zendi

  2. Deparment of Otolaryngology-Head and Neck Surgery, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia

    Fahad Nasser Altamimi

  3. College of Medicine and Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia

    Tahera Islam

  4. Department of Otolaryngology-Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

    Mohammed Humaidan Al-Harbi

  5. Department of Otolaryngology-Head & Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia

    Nader Fajhan Aldajani

Authors
  1. Khalid Al-Qahtani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fahad Nasser Altamimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammed Humaidan Al-Harbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tahera Islam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nouf Abdulkalq Al-Zendi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nader Fajhan Aldajani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Khalid Al-Qahtani.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al-Qahtani, K., Altamimi, F.N., Al-Harbi, M.H. et al. The Evaluation of the Sensitivity and Specificity of a New Endoscopic Diagnostic Sign of Allergic Fungal Rhinosinusitis: Intrapolypoidal White Particles. J. Maxillofac. Oral Surg. 20, 612–618 (2021). https://doi.org/10.1007/s12663-020-01357-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12663-020-01357-4

Keywords

search

Navigation