AlQahtani Abdulaziz, Alshaikh N, Alzarei A, Musleh A, Alamri A, Alqahtani A, Alfawwaz F, Alshammari F, Aloulah M, Marglani O, Alsaleh S, Alandejani T, Mokarbesh H
Department of Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Department of Otolaryngology Head and Neck Surgery, Dammam Medical Complex, Dammam, Saudi Arabia.
Eur Arch Otorhinolaryngol. 2017 Aug;274(8):3097-3101. doi: 10.1007/s00405-017-4604-x. Epub 2017 May 13.
Recurrence of allergic fungal rhinosinusitis (AFRS) is well recognized. However, there is scarcity in the literature describing involvement of the non-diseased sinuses. We aimed to evaluate the recurrence forms of unilateral AFRS as well as to study the possible predictor factors of developing the disease in the contralateral side. Patients with exclusive unilateral AFRS from (2010 to 2015) were enrolled in multi-institutional case-control study. All patients were evaluated after endoscopic sinus surgery for recurrence. Patient's records were reviewed for demographics, medical treatment, and clinical, radiological, and surgical data. A total of 68 patients were identified. Delayed contralateral involvement after the initial surgery was found in 30.8% with mean duration of recurrence 16.9 months. A significant association was found with the presence of pre-operative contralateral symptoms and signs of inflammation (OR 3.49, 95% CI 1.19-10.22, p value 0.02). Post-operative use of budesonide irrigation was associated with less contralateral involvement (OR 0.11, 95% CI 0.01-0.87, p value 0.01). Association of other variables like: comorbidities, perioperative use of systemic steroid, radiological signs, extent of surgery, additional surgery to the contralateral side, and post-operative use of systemic steroids did not show statistical significance. Involvement of the contralateral sinuses in 30% of unilateral AFRS cases is considered significant. The non-diseased sinuses should be involved in the routine endoscopic examination and post-operative treatment. Further studies are necessary to investigate the possibility of prophylactic surgical intervention of the non-diseased sinuses.
变应性真菌性鼻-鼻窦炎（AFRS）的复发已得到广泛认可。然而，文献中关于非患病鼻窦受累情况的描述较少。我们旨在评估单侧AFRS的复发形式，并研究对侧鼻窦发生该病的可能预测因素。纳入了2010年至2015年期间仅患有单侧AFRS的患者进行多机构病例对照研究。所有患者在内镜鼻窦手术后均接受复发情况评估。回顾患者记录以获取人口统计学信息、治疗情况以及临床、放射学和手术数据。共确定了68例患者。初次手术后发现对侧鼻窦延迟受累的比例为30.8%，复发的平均持续时间为16.9个月。发现术前对侧存在炎症症状和体征与之有显著关联（比值比3.49，95%可信区间1.19 - 10.22，p值0.02）。术后使用布地奈德冲洗与对侧鼻窦受累较少相关（比值比0.11，95%可信区间0.01 - 0.87，p值0.01）。其他变量如：合并症、围手术期全身使用类固醇、放射学征象、手术范围、对侧额外手术以及术后全身使用类固醇之间的关联未显示出统计学意义。30%的单侧AFRS病例中对侧鼻窦受累被认为具有显著性。非患病鼻窦应纳入常规内镜检查和术后治疗。有必要进一步研究探讨对非患病鼻窦进行预防性手术干预的可能性。
