الفهرس 
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Abstract
This work has aimed to evaluate the efficacy of different diagnostic modalities and therapeutic protocols of allergic fungal sinusitis, which includes wide local debridment, surgery and postoperative use of systemic steroids.
Our study was performed on fifty immunocompetent patients with bronchial asthma and chronic sinusitis with multiple polyposis resistant to medical treatment.
All patients underwent nasal surgery that comprised endoscopic ethmoidectomy (extent of which depended on the extent of the disease) and middle meatal antrostomy and placed on corticosteroid therapy.
The materials obtained were subjected to pathological examination with emphesis on the presence or absence of Hyphae and charcot Leyden crystals. Fungal growth was detected in 11cases, while the remaining 39 cases showed no fungal growth. Results of the intraoperative fungal cultures from the involved sinuses of the eleven positive cultures detected in this study yielded Aspergillus.
All patients were subjected for pre and postoperative laboratory serological tests included total IgG, specific IgG, total IgE and specific IgE for Aspergillus.
The eleven positive patients were further classified according to the presence of specfic IgE where it was found that six patients (12%) were positive (Group A: Allergic fungal sinusitis) and five patients (10%) were negative (Group B: Fungus Balls)
The pathological findings from the material obtained at time of surgery of the six immunocompetent patients met the diagnostic criteria of allergic fungal sinusitis. Results of the intraoperative fungal cultures, from the involved sinuses from the mucin of the six patients (100%) at time of surgery, yielded Aspergillus.
Preoperative total IgG levels were elevated in five patients out of six (83.3%). Total IgE levels were elevated in five patients out of six (83.3%) and specific IgE antibodies were positive in four patients out of six (66.6%). Five patients out of six (83.3%) had positive specific IgG antibodies to Aspergillus.
Follow up has ranged from one to six months. All the six patients (12%) remained symptom free after their initial endoscopic procedure and have undergone repeated endoscopic follow up examination.
Folow up of four patients out of six (66.6%) with allergic fungal sinusitis has resulted in sustained reduction of total IgE, specific IgE and oeisonophilia in each case.
Recurrent disease involving multiple sinuses became evident within four to five months of initial surgery despite steroids therapy in two patients out of six (33.3%) with allergic fungal sinusitis. Each of the two patients was treated with systemic cortocosteroids after secondary surgical procedures were performed. Follow up at six months for the two recurrent cases have resulted sustained reduction of total IgE, specific IgE and oeisonophilia. All the six patients continued to do well after prednisone tapers and continued topical nasal steroid.