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A Study on Diagnostic Indicators Differentiating AFRS and EMRS

Vijay Ramalingam, Kandasamy Kamindan, Arun Kumar and Karthikeyan

Objectives: Allergic fungal rhinosinusitis (AFRS) and Eosinophilic mucin rhinosinusitis (EMRS) are two commonly encountered entities in our institution. In this study we intended to observe the diagnostic indicators by clinical, laboratory, histopathology and radiology of these two entities. This will help us understand the disease better.

Methods: In total, 74 rhinosinusitis patients with nasal polyposis with eosinophilic mucin were enrolled. They were divided into two groups depending on the presence of fungal elements in the nasal secretion-AFRS (polyp, fungal elements, mucin) and EMRS (polyp, no fungal elements, mucin). Evaluation of these two groups included clinical assessment, mucin histopathology, serum IgE levels and Computed tomography (CT) of Paranasal sinuses (PNS) with measurement of Hyper attenuation areas (HAA) with Hounsefield units (HU).

Results: 29 patients were enrolled in AFRS group and 45 patients in the EMRS group. We observed that the EMRS group of patients had 100% bilateral presentation compared to AFRS group (31%), The IgE levels were significantly higher in the AFRS group. Hyper attenuation areas were noted only in the CT of the AFRS group measured using Hounsfield units. It was noted that bronchial asthma was more closely associated with the EMRS group.

Conclusion: AFRS occurs in individuals who develop an atopic reaction to the fungal elements within the sinuses, whereas EMRS seems to occupy the other end of spectrum where there is no trace of fungal elements but they seem to be part of a systemic disease process. This study helps us to understand the difference with regard to clinical, histopathology studies and CT-PNS in these two groups.