Efficacy of Preoperative Itraconazole in Allergic Fungal Rhinosinusitis

Abstract

Objectives:

Gold standard treatment of allergic fungal rhinosinusitis (AFS) is primary surgery followed by adjuvant therapy. Even after good surgery, recurrence rates vary from 10 to 79%. Antifungals like itraconazole and steroids have shown varying success rates in delaying recurrences given postoperatively. Itraconazole decreases need for steroids given as a primary treatment in allergic bronchopulmonary aspergillosis. This study investigates the efficacy of Itraconazole given preoperatively in AFS.

Methods:

A prospective study was carried out from July 2011 to December 2012 on twenty histologically proven patients of AFS, who were given Itraconazole preoperatively for 1 month, operated subsequently. They were compared with 20 matched controls of AFS cases, operated directly without preoperative itraconazole. Both groups were given oral steroids for 6 weeks postoperatively and followed for 3 months. Evaluations were done using symptomatic (SNOT score), radiologic (Lund Mackay scores) and endoscopic (Kupferberg Grades) parameters.

Results:

Symptomatology scores (SNOT20) decreased significantly (p=0.000) with Itraconazole. There was a significant decrease (p=0.005) in Lund Mackay scores reaching to 0 with complete resolution of disease in 15% cases with reduced hyper densities noted in all. Polyp sizes decreased and nasal endoscopic grades improved. Postoperative fungal cultures were positive in 45% compared to 79% cases among control group suggesting a decreased fungal burden. Total serum IgE decreased with itraconazole and had positive correlation (c.c=0.68) with postoperative fungal culture.

Conclusions:

We found improvements in clinical, radiologic, and endoscopic parameters in AFS after preoperative Itraconazole administration, decreasing the disease load significantly. It may prove to be a good preoperative adjunct needing further research.