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Rhinology/Allergy

A Sticky Situation: Management of Allergic Fungal Rhinosinusitis

Tuesday, October 3, 2023
4:45 PM - 5:45 PM East Coast USA Time
Location: 103BC

    Moderator(s)

  • Philip G. Chen, MD

    Professor
    University of Texas Health Science Center At San Antonio
    San Antonio, TX, United States

    • Panelist(s)

  • Amber U. Luong, MD, PhD

    Professor of Otolaryngology, Vice Chair of Academic Affairs
    University of Texas Houston, McGovern Medical School
    Houston, TX, United States

  • David W. Jang, MD

    Associate Professor
    Duke University
    Durham, NC, United States

  • ZS

    Zachary Soler, MD

    Associate Professor of Otolaryngology
    Medical University of South Carolina
    Charleston, South Carolina, USA

Disclosure(s):
Philip G. Chen, MD: No relevant relationships to disclose.
Amber U. Luong, MD, PhD: No relevant relationships to disclose.
David W. Jang, MD: No relevant relationships to disclose.
PROGRAM DESCRIPTION: Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis with nasal polyposis (CRSwNP) associated with type 2 driven IgE-mediated hypersensitivity and clinically characterized by extensive bony erosion and thick, sticky eosinophilic mucin. AFRS occurs in healthy patients often residing in warm humid climates such as the Southern United States. It not only affects quality of life but can also be locally destructive leading to proptosis, epiphora, and cranial neuropathy. Imaging often shows erosion of the skull base or orbital walls, leading to a misdiagnosis of tumor. Because of these unique features, management of AFRS can be far more complex than typical CRSwNP. Treatment commonly includes surgical management, which is often complex due to loss of bony landmarks and severe distortion of anatomy. Due to the tenacious mucin and over-expression of the innate immune system, this disease process often recurs. This panel will use case-based discussions to educate the audience with special emphasis on how it differs from typical CRSwNP. We will cover etiology, appropriate workup, medical options including biologics, surgical considerations of AFRS, and special circumstances such as management of pediatric patients.

OUTCOME OBJECTIVE 1: List the criteria used to diagnose allergic fungal sinusitis

OUTCOME OBJECTIVE 2: Discuss imaging options and characterize the findings of fungal sinusitis on the radiographic modalities.

OUTCOME OBJECTIVE 3: Evaluate the various management options for patients with allergic fungal sinusitis

BACKGROUND STATEMENT: Allergic fungal rhinosinusitis is a subtype of chronic sinusitis characterized by tenacious eosinophilic mucin. It can be locally destructive with erosions of the skull base or orbital walls. There is high risk of recurrence and therefore management can be complex and should be multi-faceted.