Most people know what a sinus infection is, but you may be surprised to learn that sinus infections and sinus disease come in many shapes and sizes.

“All types of sinus infections and sinus disease are not created equally,” says Armon Jadidian, M.D., one of the sinus and skull base surgery specialists at The Ear, Nose, Throat and Plastic Surgery Associates in Winter Park, FL.

“There certainly are different varieties or flavors of chronic sinus inflammation and infection. One that’s particularly problematic, especially in the southern United States is allergic fungal sinusitis.” This type of sinus infection can also be referred to as eosinophilic chronic sinusitis. The hallmark of this disease is allergic inflammation. We also know now that fungus is not always the allergen involved, but the disease behaves the same independent of what the sinuses are reacting to.

In other words, treatment for allergic fungal sinusitis may differ from the treatment of a standard sinus infection.

Allergic fungal sinusitis, or AFS as it is often referred, is a sinus disease where polyps form in the nose and sinuses, fungal debris accumulates causing an exaggerated amount of inflammation, and thick sticky allergic mucus forms expanding the sinuses, sometimes like a water balloon.

What Causes Allergic Fungal Sinusitis?

When a patient that is capable of producing this type of allergic inflammation comes into contact with a fungus through normal nasal breathing, it will provoke an allergic inflammatory reaction, leading to tissue edema (swelling caused by fluid retention) and polyps. The swelling will block the sinus and thick sticky mucus accumulates, producing a perfect environment for fungi to develop and expand, which in turn will trigger additional swelling. The patient’s sinuses becomes trapped in a vicious circle.

Anyone can develop AFS from young children to the elderly, however most patients present in the 30-50 year range. Many patients live with the disease for many years until it’s discovered. Often times, the symptoms develop slowly and gradually, where patients do not seek care until polyps are completely filling their nose, obstructing their breathing.

Signs and Symptoms of Allergic Fungal Sinusitis

The symptoms can be few or many. Sometimes the only symptom is difficulty breathing through their nose as a result of polyps obstructing the airway. Other common symptoms include post nasal drainage, changes to taste and smell, cough, facial pressure, headache, thick peanut butter consistency drainage from their nose, and cough. Also, over 50% of patients will have asthma in addition to this allergic based sinus disease.

“AFS causes polyps, as well as thick almost peanut butter like consistency mucus,” says Dr. Jadidian. Bad breath or foul odor can also occur from the amalgamation of fungi in the sinus cavities. Mucus may also flow down into the throat and then to the lungs, creating lung complications.

In rare cases, the nose and sinus bones may expand, pushing the eye forward or creating more striking distance between the eyes. If not treated, the symptoms of AFS will worsen over time.

How is Allergic Fungal Sinusitis Treated?

Before undergoing any medical treatment, it’s important to consult with an ENT specialist, to get a precise diagnosis and ascertain the best treatment options for your particular case of sinusitis.

The ultimate goal of treating AFS is to rid the sinuses of fungus, polyps, and mucus and to create an environment for the sinuses to recover and become healthy. A combination of surgical and medical treatment is used to accomplish this task. Surgery alone is not the answer and the disease will return 100% of the time if proper follow up and care are not taken after surgery.

Medical treatment of AFS combines using corticosteroids to decrease polyps and inflammation followed by steroid irrigations for extended periods of time after surgery to keep the sinuses healthy. Antibiotics may be needed to address any secondary bacterial infections. Anti-fungal medications are NOT needed.

Surgery is often needed initially to remove fungus, polyps, and mucus build-up from the sinus. This also helps open all of the sinuses and create access for future treatment with steroid irrigations. The procedure uses a tiny telescope connected to a camera, called an endoscope, which is threaded through the nose to perform the surgery on a video monitor in high definition.

Due to its complex nature, AFS poses considerable challenges for sinus surgeons. Having an experienced ear, nose and throat specialist in your corner is crucial to treat the disease effectively.

“These patients are particularly challenging to treat,” says Dr. Jadidian. “I was fortunate to be able to have excellent exposure in my sinus surgery fellowship to managing these patients . I’m able to offer them a lot in the form of not only surgical options but medical therapy. So, that’s part of what we accomplish here – to identify what type of chronic sinusitis the patient has and which category they fit best into to treat them.”