La Sinusite Fongique Allergique (SFA)

Maxillary sinusitis: 1752 cases at the ear-nose-throat department of a teaching hospital in Cotonou, Benin

OBJECTIVE

Maxillary sinusitis is a frequent ear-nose-throat (ENT) infection. The purpose of this study was to determine the prevalence of maxillary sinusitis in the ENT department of a teaching hospital in Cotonou, Benin, and to report the clinical findings, together with the results of complementary examinations and treatment outcomes.

PATIENTS AND METHODS

This was a retrospective descriptive analysis of patients seen at our hospital from January 1, 2004 to December 31, 2008 for maxillary sinusitis.

RESULTS

Over the 5-year study period, 1752 cases of maxillary sinusitis were treated in the ENT department of the teaching hospital, which works out to 350 or 351 cases per year. The overall prevalence was 19.3%. There were 759 patients (83.1%) aged 16-50 years, and 984 patients (56.2%) were men. Factors favoring maxillary sinusitis were: dry season with dust (n=1051 patients, 60%); and atmospheric pollution (87.6%). Maxillary sinusitis was acute for 528 patients (30.1%) and chronic for 1224 patients (69.9%). A rhinogenic cause was identified for 960 patients (54.8%), an allergic cause for 668 patients (38.1%) and a dental cause for 96 patients (55.5%). In cases of chronic sinusitis, the infection was predominantly staphylococcal (29.3%) and pneumococcal (21.9%). Basically, medical treatment was given by combining local treatments for rhinopharyngeal disinfection or vasoconstriction. In cases with a dental origin, dental care was also delivered. For allergy-related sinusitis, nasal sprays with corticosteroids and antihistamine agents were prescribed. Outcomes were favorable for 89.7% of patients.

[Allergic fungal sinusitis and allergic broncho-pulmonary aspergillosis: a fortuitous association or a nosological rhino-bronchial entity?]

INTRODUCTION

The identification of allergic fungal sinusitis (AFS) is much more recent than that of allergic broncho-pulmonary aspergillosis (ABPA) and may still be incomplete and controversial. Their association has been only rarely reported in the literature. Is it a matter of a fortuitous association or of a well defined and/or new nosological rhino-bronchial entity?

METHODS

A retrospective study was undertaken from a series of 10 cases of AFS with 4 cases associated with ABPA and fulfilling all the diagnostic criteria described in the literature.

RESULTS

The association of AFS and ABPA may be concomitant (2 cases) or not (2 cases) with a possible time lag of several years between the onset of naso-sinal and broncho-pulmonary disease, even after recovery from the original episode. Treatment comprising steroids, endoscopic surgery (4 cases) combined with anti-fungal drugs (2 cases), led to resolution (2 cases), a considerable improvement (1 case) and therapeutic failure in 1 case (follow up longer than 4 years in all cases).

CONCLUSION

The association, concomitant or remote in time, of AFS and ABPA emphasises the unity of the upper and lower airways as well as the pathophysiological relationship between these two fungal respiratory diseases. The prevalence of this association remains low and the treatment is not standardised.