A Study to Determine Role of Fungus in Cases of Chronic Rhinosinusitis with or without Nasal Polyps in Indian Population
Main Article Content
Abstract
Chronic rhinosinusitis (CRS) with or without nasal polyps is a significant public health burden worldwide and owing to its multifactorial etiology, it is often encountered across various medical and surgical specialities. Role of fungus in etiology of CRS has been debated for decades altogether and there is plethora of researches on cellular, molecular and biochemical aspects of fungal presence in nasal cavity and paranasal sinuses and how it affects. Although, there is denial at large on fungal effects on development of CRS, but the question, that whether concomitant and demonstrable presence of fungus in cases of CRS aggravates classic symptoms and signs, largely remains unanswered.
Material and Methods
This cohort study includes 121 subjects, which were divided in CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP) on basis of rigid nasal endoscopic findings. Severity of disease symptoms, among these groups was corelated with Lund – Mackay (LM) symptom scores and extent of disease with LM endoscopic staging scores and LM radiology scores. Histopathology samples for demonstrating presence of fungus were taken and cohort was further subdivided into Fungi positive CRS and Fungi negative CRS, and, LM scores were compared.
Results
In fungi positive CRS group, mean LM symptoms score was 7.09 with standard deviation (SD) ±1.07; mean LM endoscopy score was 6.64 with SD ±1.94 and LM radiological score was 14.58 with SD ±2.96. In Fungi negative group, mean LM symptoms score was 3.58 with
SD ±1.30; mean LM endoscopy score was 4.47 with SD ±1.57 and LM radiological score was 12.20 with SD ±2.98.
Conclusion
Results of this study were statistically significant that fungi positive group was found to have more severe symptoms and larger extent of disease as compared to fungi negative group which indicate that fungal presence may have a role in escalation of symptoms, signs and radiological scores and it may aggravate pre-existing CRS.
Article Details
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References
Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinol. 2020;58(Supplement 29):1-464
Chakrabarti A, Rudramurthy SM, Panda N, et al. Epidemiology of chronic fungal rhinosinusitis in rural India. Mycoses 2015;58(5):294-302
Orlandi RR, Marple BF. Fungus and chronic rhinosinusitis: weighing the evidence.
Otolaryngol Head Neck Surg. 2010;143(5):611-3
Katzenstein A-LA, Sale SR, Greenberger PA. Allergic Aspergillus sinusitis: a newly recognized form of sinusitis. J Allergy Clin Immunol. 1983;72(1):89-93
Robson JMB, Hogan PG, Benn RAV, et al. Allergic Fungal Sinusitis presenting as a paranasal sinus tumor Aust N Z J Public Health. 1989;19(4):351-3
Bent III JP, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg. 1994;111(5):580-8
Ponikau JU, Sherris DA, Kern EB, et al. The diagnosis and incidence of allergic fungal sinusitis. In: 1999:877-84: Elsevier
Ponikau JU, Sherris DA, Kephart GM, et al. The role of ubiquitous airborne fungi in chronic rhinosinusitis. Clin Rev Allergy Immunol. 2006 2006/06/01;30(3):187-94
Ponikau JU, Sherris DA. The role of airborne mold in chronic rhinosinusitis. J Allergy Clin Immunol. 2006;118(3):762
Ebbens FA, Georgalas C, Fokkens WJ. Fungus as the cause of chronic rhinosinusitis: the case remains unproven. Curr Opin Otolaryngol Head Neck Surg. 2009;17(1):43-9
Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012; 23:3 p preceding table of contents, 1-298
Hamilos DL, Lund VJ. Etiology of chronic rhinosinusitis: the role of fungus. Ann Otol Rhinol Laryngol. 2004;113(5_suppl):27-31
deShazo RD, Swain RE. Diagnostic criteria for allergic fungal sinusitis. J Allerg Clin Immunol. 1995; 96(1):24-35
Ebbens FA, Fokkens WJ. The mold conundrum in chronic rhinosinusitis: where do we stand today? Curr Allergy Asthma Rep. 2008; 8(2):93
Lanza DC, Dhong H-J, Tantilipikorn P, et al. Fungus and chronic rhinosinusitis: from bench to clinical understanding. Ann Otol Rhinol Laryngol. 2006; 115(9_suppl):27-34
Bhattacharyya N. Relationship between mucosal inflammation, computed tomography, and symptomatology in chronic rhinosinusitis without polyposis. Ann Otol Rhinol Laryngol. 2008; 117(7):517-22
Medina Banegas A, Caro López G, Gil Melgarejo JA, et al. [Nasosinusal aspergillosis]. An Otorrinolaringol Ibero Am. 1989 1989;16(6):607-18
Tosun F, Hidir Y, Saracli MA, et al. Intranasal fungi and chronic rhinosinusitis: what is the relationship? Ann Otol Rhinol Laryngol. 2007;116(6):425-9.