[Clinical characteristics and therapeutic insights of pediatric allergic fungal rhinosinusitis].

Objective

To delineate the pathogenesis, clinical spectrum, histological characteristics, imaging findings and outcomes of image-guided endoscopic sinus surgery （ESS） in pediatric allergic fungal rhinosinusitis （AFRS）.

Methods

Clinical data were collected for four pediatric AFRS patients treated between March 2018 and May 2024 at the Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital Affiliated to Zhengzhou University （Henan Children's Hospital）. Variables included electronic nasopharyngoscopy, sinus CT and MRI, pulmonary-function tests, allergen screening, total and specific serum IgE, mycological studies, and histopathological examinations. All four patients underwent ESS for sinus cavity drainage. For cases with extensive lesions involving the ethmoid or sphenoid sinuses, image-guided navigation was routinely applied intraoperatively to enhance surgical safety. Preoperative and postoperative adjunctive treatments included antibiotics, corticosteroids, leukotriene receptor antagonists, antihistamines, mucolytics, and saline nasal irrigation. Postoperative follow-up was conducted for a minimum duration of one year.

Results

Unilateral sinus involvement was identified in all four cases. The predominant clinical manifestations included nasal obstruction, rhinorrhea, sneezing, chronic cough, hyposmia, and headache. Total and specific serum IgE levels were significantly elevated, with fungal allergen grading above level 3. During navigation-assisted ESS, viscous, brownish, jam-like secretions were observed, and cultures confirmed Aspergillus flavus in all cases. Over 1-3 years of postoperative follow-up, clinical symptoms resolved completely in three patients, with good mucosal epithelialization. One patient had mild localized mucosal edema without symptoms of nasal obstruction, rhinorrhea, or headache.

Conclusion

ESS is the primary therapeutic modality for AFRS, emphasizing complete removal of allergic mucin and diseased tissue while preserving critical anatomical structures. Image-guided navigation significantly enhances surgical accuracy and safety. Perioperative adjunctive therapy, including corticosteroids, antihistamines, leukotriene receptor antagonists, and nasal irrigation, effectively reduces inflammation. Routine postoperative monitoring further decreases recurrence rates.