FREQUENCY OF ALLERGIC INTRANASAL POLYPS AND FUNGAL SINUSITIS IN SOUTHERN PUNJAB
Objective: To evaluate the frequency of fungal sinusitis in patients presenting with nasal polyps in Southern Punjab areas.
Study design: Descriptive.
Place & duration of study: Department of ENT and Head-Neck Surgery Combined Military Hospital Multan from August 2009 to July 2011.
Materials and Methods: A total of 50 immunocompetent patients with Nasal Polyps were selected. After complete history, thorough examination and routine investigations including Serum IgE, Absolute eosinophil count and CT scan Paranasal Sinuses (PNS), they were operated upon. Tissue removed was sent for Histopathology and Fungal culture.
The susceptibility to antibiotics was tested using disk diffusion method with standard antimicrobial disks (Oxoid) and adopting the method of Clinical Laboratory Standard Institute (CLSI).
Results: Male to female ratio was 1:1.7. Age range was 9 to 70 years. In 7 cases (14%) the disease was unilateral and in 43 cases (86%) the disease was bilateral. In 35 (70%) cases the disease extended to the nose, ethmoid sinuses & maxillary sinuses. In 13 (26%) cases the disease involved the frontal sinuses as well. In 2 (4%) cases, the Sphenoid sinuses were also involved. Serum IgE was raised in 41 (82%) patients while Absolute eosinophil count was raised in 47 (94%) patients. CT scan did not show bony erosions in any patient. Findings of sinusitis were present in all the patients, while double densities were found in 29 (58%) patients. Allergic mucin was present in 47 (94%) patients. Fungal studies were positive for Aspergillus species in 31 (62%) patients. Aspergillus flavus was the predominant fungus being positive in 17 (55%) patients, followed by Aspergillus fumigatus in 12 (39%) patients and Aspergillus niger in 2 (6%) patients.
Conclusion: Presence of underlying fungal sinusitis in more than 90% of the patients presenting with nasal polyps, must raise suspicion in every case presenting with nasal polyps in the region of South Punjab. This high frequency of underlying fungal sinusitis among patients with nasal polyps is probably due to warm and humid environment that is conducive for growth of fungi.
Key words: Fungal sinusitis, Immuno-competent, Nasal polyps.