AFS tends to affect multiple sinuses with a unilateral predominance. It is a slow growing and chronic entity, and bone erosion is not uncommon. This occurs in the same manner as mucoceles and polyps. Clinical Presentation and Diagnosis AFS occurs in adolescents and young adults who often have asthma that is exacerbated by their sinusitis. There is no male or female predominance.
All patients are immunocompetent and have a strong history of atopy.
There is no increased aspirin sensitivity despite the association with asthma and nasal polyps. Patients typically present to the otolaryngologist with acute worsening of their chronic sinusitis with nasal obstruction, headache, proptosis, and at times intracranial erosion. The current therapy for AFS involves surgical extirpation of all allergic mucin if possible with aeration of diseased sinuses. Endoscopic surgical decompression with adjunctive steroids are considered initially. These recurrences may be treated with adjunctive steroids and office debridement.