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<p>Allergic fungal rhinosinusitis (AFRS) frequently involves the sphenoid sinus; recurrence remains troublesome after limited sphenoidotomy. A single-centre, prospective, randomised clinical trial was conducted including 30 patients with sphenoidal AFRS who fulfilled Bent–Kuhn diagnostic criteria. Participants were randomly allocated (1:1) to endoscopic sphenoidotomy (ESO) or endoscopic sphenoid nasalisation (ESN) using a computer-generated sequence with allocation concealment. Preoperative evaluation included CT scoring (Lund–Mackay), nasal endoscopy, total serum IgE, and symptom assessment. The primary outcome was complete disease control (Kupferberg stage 0) at 12 months. Secondary outcomes included symptom improvement (VAS headache, SNOT‑22), mucosal healing (Lund–Kennedy), radiological clearance, olfactory recovery, and complications. All 30 patients completed the 12‑month follow-up. ESN resulted in a significantly higher complete control rate compared with ESO (86.7% vs. 40%, <i>p</i> = 0.0305). Symptom improvement was significantly greater after ESN, including reductions in headache scores (6.2 ± 1.0 vs. 4.5 ± 1.2; <i>p</i> = 0.03) and SNOT‑22 (30 ± 6 vs. 20 ± 6; <i>p</i> &lt; 0.01). ESN achieved better mucosal healing (2.8 ± 1.2 vs. 4.5 ± 1.5; <i>p</i> = 0.01), greater radiological improvement (8 ± 1.5 vs. 6 ± 2; <i>p</i> = 0.02), and earlier olfactory recovery (6 ± 1.5 vs. 9 ± 2 months; <i>p</i> = 0.02). Recurrence occurred in 4 ESO patients but in none of the ESN group. Complications were minimal and similar across groups. ESN offers superior long-term disease control, symptom relief and olfactory recovery with similar safety compared with conventional ESO, supporting nasalisation as the preferred technique for sphenoidal-AFRS. This trial was not recorded since it was initiated by the investigator and approved by the institution’s ethics committee prior to recruitment.</p>

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Value of Endoscopic Sphenoid Nasalisation in Management of Allergic Fungal Sinusitis Involving Sphenoidal Sinus

  • 期刊论文

  • 发表日期：

    2026年4月18日

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  • Mina Safwat Fahim Sourial,
  • Hussam Eldin Mahmoud Mohammed ElBosraty,
  • Ahmed Mohammed Atef,
  • Mohamed Hamdy Mohamed El-Sagher,
  • Ahmed Mohamed Awad

摘要

Allergic fungal rhinosinusitis (AFRS) frequently involves the sphenoid sinus; recurrence remains troublesome after limited sphenoidotomy. A single-centre, prospective, randomised clinical trial was conducted including 30 patients with sphenoidal AFRS who fulfilled Bent–Kuhn diagnostic criteria. Participants were randomly allocated (1:1) to endoscopic sphenoidotomy (ESO) or endoscopic sphenoid nasalisation (ESN) using a computer-generated sequence with allocation concealment. Preoperative evaluation included CT scoring (Lund–Mackay), nasal endoscopy, total serum IgE, and symptom assessment. The primary outcome was complete disease control (Kupferberg stage 0) at 12 months. Secondary outcomes included symptom improvement (VAS headache, SNOT‑22), mucosal healing (Lund–Kennedy), radiological clearance, olfactory recovery, and complications. All 30 patients completed the 12‑month follow-up. ESN resulted in a significantly higher complete control rate compared with ESO (86.7% vs. 40%, p = 0.0305). Symptom improvement was significantly greater after ESN, including reductions in headache scores (6.2 ± 1.0 vs. 4.5 ± 1.2; p = 0.03) and SNOT‑22 (30 ± 6 vs. 20 ± 6; p < 0.01). ESN achieved better mucosal healing (2.8 ± 1.2 vs. 4.5 ± 1.5; p = 0.01), greater radiological improvement (8 ± 1.5 vs. 6 ± 2; p = 0.02), and earlier olfactory recovery (6 ± 1.5 vs. 9 ± 2 months; p = 0.02). Recurrence occurred in 4 ESO patients but in none of the ESN group. Complications were minimal and similar across groups. ESN offers superior long-term disease control, symptom relief and olfactory recovery with similar safety compared with conventional ESO, supporting nasalisation as the preferred technique for sphenoidal-AFRS. This trial was not recorded since it was initiated by the investigator and approved by the institution’s ethics committee prior to recruitment.