Investigation of Concha Bullosa in CT scan: A Comparative Study Between Patients with Allergic Fungal Rhinosinusitis and Non-fungal Rhinosinusitis with Polyposis with Culture of Secretions

Concha Bullosa in Allergic Fungal Rhinosinusitis and Non-fungal rhinosinusitis with polyposis

Abstract

Background: Understanding the radiographic and anatomical distinctions in patients with allergic fungal rhinosinusitis (AFRS) is crucial for effective treatment and recurrence prevention. Current study aimed to investigate the presence of Concha bullosa in CT scans of patients with AFRS compared to patients with non-fungal rhinosinusitis with polyposis (NFRP), alongside the culture of the secretions. Materials and Methods: This cross-sectional study involved 86 patients with an average age of 40.91 ± 13.45 years, all suffering from nasal polyps and undergoing endoscopic sinus surgery at the Amir Alam Hospital. Participants were divided into two groups; AFRS group (n=43), and NFRP group (n=43). CT scans of the paranasal sinuses were conducted for all patients. Additionally, assessments were made for fungal cultures from Concha bullosa secretions, sinus secretions, and polyp tissue. Results: The average age of patients in the AFRS group was significantly lower than that of the NFRP group (37.3 years vs. 44.5 years, P=0.012). The incidence of Concha bullosa with secretion was higher than the ones without secretion. Notably, the AFRS group exhibited a significantly greater prevalence of Concha bullosa with secretion compared to the NFRP group (44.2% vs. 18.6%, P=0.034). In terms of fungal cultures, Aspergillus was the only positive finding in the AFRS group (13.5%, n=5) and in the NFRP group (6.1%, n=2). The species Aspergillus flavus (4.3%, n=3) was more frequently identified in fungal cultures from sinus secretions and polyp tissue among AFRS group. Conclusion: Concha bullosa is more common in the AFRS group than in the NFRP group. It suggests a potential association between fungal colonization and disease recurrence. Also, Aspergillus, especially Aspergillus flavus, are frequently found in AFRS group, pointing to the role in the disease. The findings stress the need to consider Concha bullosa when treating AFRS to enhance outcomes and lower recurrence rates.