Abstract
Objective: 1) Diagnose fungal disease in sinonasal polyposis. 2) Compare the clinical outcome of patients with sinonasal polyposis treated with and without itraconazole.
Method: Two-year, randomized case controlled study in university hospital. Thirty patients with sinonasal polyposis. Random allocation to study and control group. All underwent nasal endoscopy, CT PNS, Nasal swab for fungal smear and culture. Study group received itraconazole, per oral for 2 and 4 weeks pre- and postoperative period.
Results: A total of 60% of preoperative nasal swab were KOH positive for fungal hyphae. Both groups presented with headache and nasal obstruction. Wormald classification was used to grade polyps, edema, and discharge. Fungus was isolated in 46% of study and 34% of control group; the predominant fungus grown was Aspergillus flavus. Histopathology showed 66% inflammatory polyps and 44% allergic polyps. Statistical analysis and comparison of control and study group showed significantly lower clinical scores in study (itraconazole) group (P < .002) at 6 months posttreatment. The Lund Mackay score for CT scan did not show significant difference.
Conclusion: Fungal disease co-exists in a majority of patients with sinonasal polyposis. It is not known if it is a causative factor. Itraconazole was found to improve the clinical outcome in patients treated for sinonasal polyposis. No untoward side effects of the drug was identified in our study.
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