Targeted endoscopic surgery for allergic fungal rhinosinusitis

The current, most widely accepted protocol for the treatment of allergic fungal rhinosinusitis includes endoscopic sinus surgery, followed by a prolonged course of steroid treatment. We describe a new protocol for the perioperative treatment of allergic fungal rhinosinusitis: (1) preoperative prednisone 1 mg/kg/d for 10 days; (2) computerized tomography (CT) 1 day before surgery; (3) endoscopic sinus surgery targeted to allergic mucin foci remnants according to their precise location as seen on CT after steroid treatment; and (4) postoperative tapering of prednisone over 6-9 days. Preoperative treatment with high-dose steroids provides the endoscopic surgeon with a surgical field that is much easier to control. Precision surgery reduces operation time and can obviate unnecessarily extensive surgery and potentially associated complications. According to our experience, this management appears to improve the outcome of patients with allergic fungal rhinosinusitis compared to the outcome of alternative approaches described in the literature.