Correlation of Clinical and Hematological Findings with the Bony Erosion in Patients of Allergic Fungal Sinusitis

Variation in the clinical, hematological parameters in patients of AFRS has well been documented in the past literatures. Few studies have also reported erosion of bony sinus and skull base in patients associated with AFRS. However we have focused the correlation of clinical, hematological and microbiological findings with that of the CT findings in 80 patients of AFRS, diagnosed by Bent and Kuhn's criteria. Material and Method: This was a prospective study conducted in the department in otorhinolaryngology in a tertiary care referral hospital from July 2013 to January 2015.Total 80 patients (50 primary cases and 30 revision cases) of AFRS with nasal polyposis were included in the study. Clinical (Sino-Nasal Outcome Test [SNOT-20], hematological tests (absolute eosinophil count, Serum IgE) and microbiological findings were correlated with the CT scan. Result: Characteristic heterogeneous density in CT scan finding was present in 60(75%) patients and combined skull base and orbital erosion was found in 18 cases. Average pretreatment AEC level in the primary and revision cases were 532 microg/L and 592microg/L respectively and whenbone erosion was taken in to account, these values were 570 microg/L and 510 microg/L respectively (P=0.093). The mean serum IgE level in primary and revision patients were 850.20IU/ml and 790 IU/mlrespectively and the respective values were 855 IU/ml and 827 IU/mlon correlation with the bone erosion(p=0.062). Similarly the mean SNOT score was 52.5(51 for primary and 66 for revision cases) and on considering the bony erosion it was found to be 68.4(59 for primary cases and 62.75 for revision cases) (p=0.148). Conclusion: Characteristics CT finding is an important parameter for the clinical diagnosis of AFRS. Although clinical and hematological parameters are closely related to each other, there was no direct relationship between patients with and without erosion of the bone.