2017 Volume 120 Issue 12 Pages 1457-1466
Allergic Fungal Rhinosinusitis (AFRS), a form of refractory rhinosinusitis, is caused by an allergic response to fungi. While AFRS has been reported from Western countries, it has not been studied extensively in Japan. To determine the characteristics of AFRS in the Japanese population, we analyzed 8 clinical cases encountered at our institute and reviewed 29 other cases reported nationwide. Japanese patients with AFRS were 45 years of age, on average, which was lower than the average age of patients with chronic rhinosinusitis. AFRS can be unilateral or bilateral, and was found to be unilateral in 69.7% of the affected Japanese patients. These results are comparable to those reported for AFRS patients in Western countries. Japanese patients with AFRS were found to be most commonly allergic to the fungus Aspergillus. On computed tomography (CT), hyperdensities, indicative of allergic mucin, were detected in the nasal sinus(es) in all cases. Concomitantly, T2-weighted magnetic resonance images (MRI) showed hypointense areas in the nasal sinus (es), also indicative of allergic mucin. Hence, both CT and MRI are useful for diagnosing AFRS. In addition, some studies reported the benefits of postoperative glucocorticoid therapy after endoscopic sinus surgery (ESS). Hence, we determined the recurrence rates in groups of patients that received/did not receive postoperative glucocorticoid therapy, and found similar recurrence rates in the two groups. However, bone erosion was more frequent in the group that received postoperative glucocorticoid therapy, which possibly indicates that the disease was more severe in the group that received postoperative glucocorticoid therapy than in the group that did not receive glucocorticoids postoperatively. Further studies are required to elucidate the characteristics and appropriate postoperative management of AFRS in the Japanese population.
