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What is the cause and treatment for Allergic fungal sinusitis?

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ENT Specialist
Practicing since : 1998
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I have had allergy testing and I am highly allergic to mold. I have sinusitis and have taken antibiotics but they did not help. I have also tried nasal irrigation but nothing seems to help. I have had severe sinus symptoms for over a month. I have had a ct scan and it shows sinus disease. My doctor saw pus in my throat but the mucus that comes out of my nose is clear. I have recently discovered mold in my basement and I have heating ductwork in the basement. Is it possible that this case of sinusitis is not bacterial but is caused by an allergic response to the mold in the basement.
Posted Sun, 19 Jan 2014 in Asthma and Allergy
Answered by Dr. Prahlad Duggal 7 hours later
Brief Answer: Bact & fungal sinusitis have diff picture on CT Detailed Answer: Hi, Thanks for the query. Bacterial and fungal sinusitis have different pictures usually on CT scan. Allergic fungal sinusitis is because of the reaction of the sinus mucosal lining to the fungal spore which enters that sinus. Usually body immunity makes that sinus to push out that fungus and restore the environment of the sinus. Sometimes that does not happen and an allergic reaction ensues which leads to a fungal ball like formation in the sinus because of fungal elements and inspissated secretions. Superadded bacterial infection can occur in this environment. The picture is characteristic on CT in most of the patients with hypo and hyperdense areas in the sinus. The treatment for this is surgical and endoscopic debridement helps. Bacterial sinusitis is due to bacterial infection in the sinuses usually secondary to blockade in drainage and ventilation of sinuses. This produces acute symptoms to start with and if treatment gives incomplete cure or if anatomical factors are there, the changes can become chronic. Medical and surgical both treatments are required for this but decision to select the patient for surgical treatment is to be taken by treating ENT based on CT findings, duration and frequency of symptoms and the severity of problem. Surgery is usually endoscopic. A combination of both can be there in few patients. Nasal irrigation post debridement helps in fungal sinusitis and not of much help otherwise in well established fungal disease. Invasive fungal sinusitis can be there in immunocompromized patients and should be treated urgently. Feel free to ask another query. Regards
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Follow-up: What is the cause and treatment for Allergic fungal sinusitis? 3 hours later
How could it be determined if it is fungal or bacterial. Would the ct scan show if it is fungal sinusitis or bacterial? My GP doctor did not mention anything about a fungal ball on the results of my ct scan. Should the ct results be reviewed by an ENT to determine this?
Answered by Dr. Prahlad Duggal 1 hour later
Brief Answer: CT finding are to be reported by radiologist Detailed Answer: Thanks for the query. To determine that the sinusitis is bacterial or fungal, confirmatory is endoscopic surgery and testing the material from the sinus for bacterial and fungal smear and culture and sensitivity. But CT scan is a very good indicator of fungal sinusitis and will show: Hypo and hyper dense areas in the involved sinuses & expansion and thinning of sinus walls. There can be some loss of intersinus septa also. Bacterial sinusitis will only show a soft tissue shadow in the involved sinuses. There can be presence of air fluid shadows also in the sinus. A CT scan is to be reported by a radiologist and he/she will report if there is a possibility of fungal sinusitis on CT. An ENT can also examine the CT and tell about the possibility of fungal sinusitis but review by an ENT is not must and CT reporting is the job of a radiologist. If your does not mention fungal ball, the chances of it being a bacterial sinusitis are higher which in many cases has an additive factor of allergy in the background. Feel free to ask another query. Regards
Above answer was peer-reviewed by
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