Comparison of recurrence of allergic fungal rhinosinusitis after endoscopic sinus surgery using steroids with or without itraconazole
DOI:
https://doi.org/10.61529/idjp.v34i2.390Abstract
Background: Allergic fungal rhinosinusitis (AFRS) is subtype of chronic rhinosinusitis characterized by hypersensitivity reaction to fungal elements, leading to persistent inflammation and a high recurrence rate after Endoscopic Sinus Surgery (ESS). To compare recurrence rates, symptom improvement, and quality of life outcomes in AFRS patients receiving postoperative corticosteroids alone versus those receiving a combination of corticosteroids and itraconazole following ESS.
Material and Methods: A cross-sectional analytical study was conducted at Bahawal Victoria Hospital, Bahawalpur, from July 2023 to December 2024. Patients diagnosed with AFRS based on Bent and Kuhn criteria who underwent ESS were categorized into two groups based on postoperative therapy: Group A (Corticosteroids Only) and Group B (Corticosteroids + Itraconazole). Primary outcomes included recurrence rates at 12 months post-surgery. Secondary outcomes assessed symptom improvement using SNOT-22 scores and quality of life using RSDI scores. Statistical analysis was performed using SPSS version 24.0.
Results: Baseline characteristics were comparable between groups. The recurrence rate was significantly lower in Group B (10.0%) than in Group A (25.5%) (p = 0.004). Group B also demonstrated greater reductions in SNOT-22 (20 vs. 12 points, p< 0.001) and RSDI scores (25 vs. 15 points, p< 0.001), indicating better symptom relief and quality of life improvement.
Conclusion: Addition of itraconazole to corticosteroid therapy significantly reduces AFRS recurrence rates and enhances post-surgical symptom relief and quality of life.
Keywords: Allergic Fungal Rhinosinusitis, Endoscopic sinus surgery, Corticosteroids, Itraconazole, Recurrence
References
Rojita M, Samal S, Pradhan P, Venkatachalam VP. Comparison of steroid and itraconazole for prevention of recurrence in allergic fungal rhinosinusitis: a randomized controlled trial. 2017;11(4):MC01-03. DOI: https://doi.org/10.7860/jcdr/2017/23488.9610
Salil A, Joy N, Faizal B. A prospective study comparing itraconazole alone versus systemic steroids alone as adjuncts to topical steroids in the post‐operative management of allergic fungal rhinosinusitis. 2023; 48(2): 356-62. DOI: https://doi.org/10.1111/coa.14014
Reda R, Wageh W, Fawaz M, Mikhaiel W. Comparison between local steroids and local steroids plus itraconazole effect in prevention of recurrence of allergic fungal sinusitis in hypertensive and/ or diabetic patients. 2019; 35:25-9.
DOI: https://doi.org/10.7860/JCDR/2017/23488.9610
Shah B, Kajal S, Bhalla A, Madan K, Viswanathan G, Thakar A, et al. Prolonged itraconazole therapy as sole treatment for patients with allergic fungal rhinosinusitis. 2024; 134(2): 545-51. DOI: https://doi.org/10.1002/lary.30841
Patro SK, Verma RK, Panda NK, Chakrabarti A, Singh P. Efficacy of preoperative itraconazole in allergic fungal rhinosinusitis. Am J Rhinol Allergy. 2015; 29(4): 299-304. DOI: https://doi.org/10.2500/ajra.2015.29.4187
Salil A, Joy N, Faizal B. A prospective study comparing Itraconazole and systemic steroids as an adjunct to topical steroids in the post-operative management of allergic fungal rhinosinusitis. Clin Otolaryngol. 2023; 48(2): 356-62. DOI: https://doi.org/10.1111/coa.14014
Mostafa BE, Fadel M, Mohammed MA, Hamdi TA, Askoura AM. Omalizumab versus intranasal steroids in the post-operative management of patients with allergic fungal rhinosinusitis. Eur Arch Otorhinolaryngol. 2020; 277(1): 121-8. DOI: https://doi.org/10.1007/s00405-019-05650-y
Medikeri G, Javer A. Optimal management of allergic fungal rhinosinusitis. J Asthma Allergy. 2020; 13: 323-32.
DOI: https://doi.org/10.2147/JAA.S217658
Thanasumpun T, Batra PS. Oral antifungal therapy for chronic rhinosinusitis and its subtypes: A systematic review. Int Forum Allergy Rhinol. 2011; 1 (5): 382-9. DOI: https://doi.org/10.1002/alr.20088
Mahfouz El-Ghadafi AY, Tantawy AZ, Elnashar I, Said A. The role of systemic itraconazole in management of allergic fungal rhinosinusitis. Zagazig Uni Med J. 2022; 28(6.2): 66-73. DOI: https://doi.org/10.21608/zumj.2019.16399.1466
Ponikau JU, Sherris DA, Kephart GM, Kern EB, Congdon DJ, Winn DM, et al. Features of allergic fungal sinusitis and its relation to eosinophilic mucin rhinosinusitis. J Allergy Clin Immunol. 2005; 115(2): 426-7. DOI: https://doi.org/10.1016/j.jaci.2004.10.039
Ebbens FA, Georgalas C, Fokkens WJ. The efficacy of antifungal therapy in allergic fungal rhinosinusitis: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2006; 118(3): 725-32. DOI: https://doi.org/10.1016/j.jaci.2006.06.019
Head K, Sharp S, Chong LY, Hopkins C, Philpott C. Topical and systemic antifungal therapy for chronic rhinosinusitis. Cochrane Database Syst Rev. 2018 Sep 10;9(9):CD012453.
DOI: https://doi.org/10.1002/14651858.cd012453.pub2
Hashemi M, Fereidani A, Berjis N, Okhovat SA, Eshaghain A. Effectiveness of itraconazole on clinical symptoms and radiologic findings in patients with recurrent chronic rhinosinusitis and nasal polyposis. Adv Biomed Res. 2014; 3(1): 162. DOI: https://doi.org/10.4103/2277-9175.139124
Chua AJ, Jafar A, Luong AU. Update on allergic fungal rhinosinusitis. Ann Allergy Asthma Immunol. 2023; 131(3): 300-6. DOI: https://doi.org/10.1016/j.anai.2023.02.018
Mamatha KR, Sankar RG, Varghese GT, Puttamadaiah G, Suhas K. A study to assess the efficacy of oral itraconazole as an add-on to steroids in allergic fungal rhinosinusitis in a tertiary care hospital. Natl J Physiol Pharm Pharmacol. 2024; 14(8): 1598-602. DOI:http://dx.doi.org/10.5455/njppp.2024.14.12572202322022024
Afzal M, Baloch MO, Nadeem MA. Efficacy of post-operative oral prednisolone for the control of disease in allergic fungal sinusitis. JSZMC. 2021; 12(02): 13-7. Available from: https://journalszmc.com/ojs/index.php/ jszmc/article/view/47/65
Ferguson BJ. What role do systemic corticosteroids, immunotherapy, and antifungal drugs play in the therapy of allergic fungal rhinosinusitis? Arch Otolaryngol Head Neck Surg. 1998; 124(10): 1174-8. DOI: https://doi.org/10.1001/archotol.124.10.1174
Masterson L, Egro FM, Bewick J, Erskine SE, Clark A, Javer AR, et al. Quality-of-life outcomes after sinus surgery in allergic fungal rhinosinusitis versus nonfungal chronic rhinosinusitis. Am J Rhinol Allergy. 2016; 30(2): e30-5. DOI: https://doi.org/10.2500/ajra.2016.30.4280
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