Allergic fungal sinusitis in children in Saudi Arabia

OBJECTIVE: To report the allergic fungal sinusitis (AFS) in children in Saudi Arabia and to review the experience of King Abdul-Aziz University Hospital in diagnosis and management of AFS in children.

METHODS: Hospital charts of 45 children reviewed retrospectively. Clinical presentation, radiological and operative findings, management and outcomes studied. Only 25 patients had =/> 4 diagnostic criteria, treated endoscopically between January 2000 and December 2005 and followed at least 2 years in KAUH, Riyadh, Kingdom of Saudi Arabia.

RESULTS: Twenty-five patients had at least 4 criteria for AFS. All patients underwent functional endoscopic sinus surgery (FESS) with high recurrence rate, 44%. Twenty-eight percent needed revision surgery even with medical treatment post operatively. Moreover, no other complications were reported in this study. Aspergillus spp is the most common fungal type in our review.

CONCLUSION: Allergic fungal sinusitis in children is underestimated and understudied associated with poor outcome and high recurrence rate because of difficulty in management. Therefore, the most effective approach of AFS management in children is to have a high index of suspicion, adequate preoperative evaluation, medical preparation preoperatively, meticulous surgery, medical management, postoperative including topical and systemic corticosteroids and close clinical follow-up with endoscopically guided debridement.