Saravanan Karuppiah, Panda Naresh K, Chakrabarti Arunaloke, Das Ashim, Bapuraj Rajeev J
Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Arch Otolaryngol Head Neck Surg. 2006 Feb;132(2):173-8. doi: 10.1001/archotol.132.2.173.
To resolve the diagnostic dilemma of allergic fungal rhinosinusitis (AFRS), an increasingly recognized type of chronic rhinosinusitis (CRS). In spite of extensive studies, controversy exists regarding the etiologic characteristics, pathogenesis, and diagnosis of this entity.
Prospective, comparative study.
Department of Otolaryngology-Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Seventy consecutive patients with CRS, with or without polyps.
Patients were evaluated by detailed clinical examination, computed tomography (CT), skin test against aspergillin antigen (47 patients), and histopathologic and mycologic monitoring. Based on the presence or absence of allergic mucin (M) and mycelial element (F) in the sinus, the patients were divided into 4 groups: M+F+ (likely AFRS group), M+F- (likely eosinophilic mucin rhinosinusitis), M-F+ (likely sinus mycetoma), and M-F- (CRS from other causes). The different parameters were compared in these 4 groups.
Thirty-six patients were categorized in the likely AFRS group, 12 with eosinophilic mucin rhinosinusitis, 4 with sinus mycetoma, and 18 with CRS from other causes. Despite considerable overlap among different groups, the following parameters were significantly more associated with AFRS group: type 1 hypersensitivity (P<.05), Charcot-Leyden crystals (P<.001), bony erosion (P<.001), and heterogeneous opacity with sinus expansion on CT scan (P<.05). The above results were further validated in those patients for whom all investigations were conducted (n = 47). The significance of these 4 parameters with regard to AFRS was reconfirmed in those 47 patients.
To diagnose AFRS, important findings should be considered in addition to the detection of fungal elements and allergic mucin: Charcot-Leyden crystals, type 1 hypersensitivity, bony erosion, and heterogeneous opacity with sinus expansion on CT. The last 3 of these parameters may predict AFRS preoperatively.
解决变应性真菌性鼻-鼻窦炎（AFRS）这一日益被认识的慢性鼻-鼻窦炎（CRS）类型的诊断难题。尽管进行了广泛研究，但关于该疾病的病因特征、发病机制及诊断仍存在争议。
前瞻性比较研究。
印度昌迪加尔医学教育与研究研究生院耳鼻咽喉-头颈外科。
70例连续性CRS患者，有或无息肉。
对患者进行详细临床检查、计算机断层扫描（CT）、针对曲霉菌抗原的皮肤试验（47例患者）以及组织病理学和真菌学监测。根据鼻窦中变应性黏液（M）和菌丝成分（F）的有无，将患者分为4组：M+F+（可能为AFRS组）、M+F-（可能为嗜酸性黏液性鼻-鼻窦炎）、M-F+（可能为鼻窦真菌瘤）和M-F-（其他原因引起的CRS）。比较这4组中的不同参数。
36例患者被归类为可能的AFRS组，12例为嗜酸性黏液性鼻-鼻窦炎，4例为鼻窦真菌瘤，18例为其他原因引起的CRS。尽管不同组之间存在相当大的重叠，但以下参数与AFRS组显著相关：1型超敏反应（P<0.05）、夏科-莱登结晶（P<0.001）、骨质侵蚀（P<0.001）以及CT扫描显示鼻窦扩张的不均匀混浊（P<0.05）。在所有检查均完成的患者（n = 47）中进一步验证了上述结果。这4个参数对AFRS的意义在这47例患者中再次得到证实。
诊断AFRS时，除了检测真菌成分和变应性黏液外，还应考虑重要发现：夏科-莱登结晶、1型超敏反应、骨质侵蚀以及CT上鼻窦扩张的不均匀混浊。其中后3个参数可能在术前预测AFRS。
