Bony Erosion Patterns in Patients with Allergic Fungal Sinusitis

OBJECTIVE: To investigate bony erosion patterns in allergic fungal sinusitis (AFS) and to determine whether the extent of erosion correlates with demographics and preoperative clinical parameters. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Seventy-four patients with a histopathologic diagnosis of AFS were identified. Preoperative computed tomographies (CT) were reviewed to determine sites with bony erosion. The 20-item Sinonasal Outcomes Test (SNOT-20) scores, endoscopy scores, and Lund-Mackay CT scores were compared between patients with and without bony erosion. Patients with bony erosion were further classified based on the extent of erosion. Statistical analysis was performed by using the Student's t-test and the χ(2) test of independence. RESULTS: Of the 74 patients, 39 (52.7%) had bony erosion and 35 (47.3%) did not. Bony erosion was found to be associated with younger age (27.5 versus 36.0 years; p = 0.011) and African American race (p = 0.041). Preoperative CT scores correlated with the presence and extent of bony erosion (p = 0.010). Sex, race, number of previous surgeries, SNOT-20 scores, and endoscopy scores did not correlate significantly. CONCLUSION: Younger age and African American race were found to significantly correlate with bony erosion in AFS, which indicated that a more severe inflammatory response was mounted in these patient groups. As expected, higher Lund-Mackay scores correlated with the severity of erosion. The lack of correlation with SNOT-20 scores indicated the insidious nature of this destructive disease. The level of evidence is 4.