Khalil Yaser, Tharwat Adel, Abdou Asmaa Gaber, Essa Enas, Elsawy Abdel Hamid, Elnakib Osama, Elnaidany Nada Farag
Department of Otolaryngology, Menofiya University Faculty of Medicine, Gamal Abd Elnaser St., 32511 Shebein Elkom, Egypt.
Ear Nose Throat J. 2011 Aug;90(8):E1-7. doi: 10.1177/014556131109000815.
Allergic fungal rhinosinusitis (AFRS) is the most common form of fungal sinus disease. Its recurrence rate is high despite numerous strategies to prevent it. We conducted a study to assess the effect of systemic and topical antifungal agents-both separately and in combination-in preventing recurrence of AFRS following functional endoscopic sinus surgery (FESS). Our initial study population was made up of 50 adults who were diagnosed with AFRS by clinical, radiologic, histopathologic, and laboratory workup and who subsequently underwent FESS. Postoperatively, these patients were randomized into 5 different treatment groups matched for sex, age, and socioeconomic status. Four of the groups received a different antifungal regimen in addition to convenient medical treatment (CMT), while a fifth group served as a control. The antifungal regimens included oral itraconazole (group A), fluconazole nasal spray (group B), combined oral itraconazole and nasal fluconazole (group C), and irrigation with a fluconazole solution through the nasal fossa (group D); the group of 10 controls (group E) received CMT only. A total of 41 patients were available for follow-up (9 mo maximum). Recurrence rates in the 5 groups were 66.7, 10.0, 14.3, 28.6, and 75.0%, respectively. Based on our findings, we conclude that treatment with topical fluconazole as either a nasal spray or an irrigation solution can significantly reduce the rate of recurrence of AFRS after FESS.
变应性真菌性鼻-鼻窦炎（AFRS）是真菌性鼻窦疾病最常见的形式。尽管有多种预防策略，但其复发率仍很高。我们开展了一项研究，以评估全身性和局部抗真菌药物单独及联合使用在预防功能性鼻内镜鼻窦手术（FESS）后AFRS复发方面的效果。我们最初的研究对象由50名成年人组成，他们经临床、影像学、组织病理学和实验室检查确诊为AFRS，随后接受了FESS。术后，这些患者被随机分为5个不同的治疗组，根据性别、年龄和社会经济状况进行匹配。其中4个组除接受常规药物治疗（CMT）外，还接受了不同的抗真菌治疗方案，而第5组作为对照组。抗真菌治疗方案包括口服伊曲康唑（A组）、氟康唑鼻喷雾剂（B组）、口服伊曲康唑联合鼻用氟康唑（C组）以及通过鼻腔用氟康唑溶液冲洗（D组）；10名对照组患者（E组）仅接受CMT。共有41例患者可供随访（最长9个月）。5组的复发率分别为66.7%、10.0%、14.3%、28.6%和75.0%。根据我们的研究结果，我们得出结论，局部使用氟康唑作为鼻喷雾剂或冲洗液进行治疗可显著降低FESS后AFRS的复发率。
