Clinical Characteristics of Allergic Fungal Sinusitis: A Retrospective Analysis From Two Health Centers in Kuwait

Introduction Allergic fungal sinusitis (AFS) is a noninvasive form of chronic rhinosinusitis (CRS) driven by an allergic response to fungal organisms, primarily affecting atopic individuals. It represents a clinically significant yet frequently underrecognized condition. AFS commonly presents with nasal polyps, and their co-occurrence can aid early diagnosis. Understanding this relationship is essential, as delayed recognition may lead to recurrent symptoms and the need for more aggressive intervention. Methods A retrospective cohort study was conducted on 110 adult patients with nasal polyposis who underwent functional endoscopic sinus surgery (FESS) between 2013 and 2019 at Zain Hospital and Jaber Al-Ahmad Al-Sabah Hospital in Kuwait. Patients were selected using consecutive sampling from operative records during the study period. The inclusion criteria encompassed adult patients of any age, gender, or nationality with clinically and radiologically confirmed nasal polyposis treated operatively at either center. The exclusion criteria included patients without nasal polyps, incomplete or missing medical records, sinonasal malignancies, non-inflammatory pathologies, or significant immunocompromising conditions unless stable at the time of surgery. Patients operated on outside the study centers were also excluded. Allergic fungal rhinosinusitis (AFRS) diagnosis was established through allergic mucin gram staining, computed tomography (CT) imaging, and histopathological confirmation. Primary outcome assessed AFRS prevalence; secondary outcomes analyzed recurrence patterns in relation to Lund-Mackay (LM) scores, fungal status, age, and gender. Results As per the histopathological findings for fungal sinusitis among the patients with nasal polyposis, 22/110 (20%) patients were positive for AFRS. An overall recurrence rate of 37.27% (41/110 patients) for patients with nasal polyps was found alongside a recurrence rate of 27.27% (6/22) for patients with AFRS. Recurrence rates were stratified according to Lund-Mackay (LM) scores of ≤12 and >12; results showed that recurrence rates for patients with LM scores of ≤12 were 39.1% (9/23) and 31.5% (23/73) for those with LM scores of >12. LM scores were not a significant factor in the recurrence rate of fungal sinusitis (χ²(1) = 0.03 and p = 0.86). Conclusion Identifying allergic fungal rhinosinusitis (AFRS) in patients with nasal polyps is critical for guiding appropriate management and improving outcomes. This study found a statistically significant association between gender and AFRS prevalence. Further research is needed to validate this correlation and to explore underlying mechanisms. Ongoing prevalence studies are also essential for understanding epidemiological trends and informing public health strategies.