Role of the oral itraconazole in the postoperative management of allergic fungal rhinosinusitis

Background: Allergic Fungal Rhinosinusitis (AFRS) is the most common form of fungal sinus disease. Its recurrence rate is high despite numerous strategies to prevent it. The addition of an oral antifungal agent may prolong the disease-free period. Aim: The aim of this study is to see the outcome of Functional Endoscopic Sinus Surgery (FESS) in allergic fungal rhinosinusitis, with the addition of oral Itraconazole to the current postoperative treatment regimen. Methodology: The study was conducted at the Department of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka from April 2023 to September 2024. The subjects were selected on the basis of inclusion and exclusion, also diagnosed with Allergic Fungal Rhinosinusitis (AFRS) based on a modification of the Bent and Kuhn criteria. This prospective observational study was done on 40 (N=40) diagnosed cases of AFRS, who underwent Functional Endoscopic Sinus Surgery (FESS/ESS). The post-operative patients were divided into two groups as: Group A (N1=20), received capsule itraconazole orally (100 mg twice daily for 2 months), Group B (N2=20), did not received oral itraconazole. Both the groups received regular postoperative nasal douching (500 ml normal saline with 2 ampule budesonide 0.5mg/2ml with 50 c.c syringe) 3 times daily for 6 months. The outcomes were measured within 6 months by Kupferberg endoscopic staging & S.IgE level. Results: The age group with the highest frequency was 18-28 years. In Group A, 70% of people had bilateral nasal polyps, showing it was more common than in Group B. Both groups' pre- and post-operative (after 6 wks) IgE levels were examined. IgE levels significantly decreased in both groups, with Group A having a significantly lower mean level (124.35 ± 64.8) than Group B (449.2 ± 198.1). The pre- to post-operative IgE reduction in each group was similarly statistically significant (p = 0.001). This suggested that the oral itraconazole, whether surgery alone or combined with Itraconazole, significantly reduced IgE levels in both groups. SGPT levels were evaluated between groups for liver function. Postoperatively after two months, Group A had a mean SGPT level of 73.3 ± 94.86, whereas Group B had 56.4 ± 85.64, with a p-value of 0.558, indicating no significant difference. The p-values for one month (p = 0.100) and two months (p = 0.293) revealed that the two groups had similar SGPT levels at both time points. It appears that the intervention did not affect liver function as evaluated by SGPT. At the 4th and 12th weeks, neither group had recurrences but at the 24th week, the Group B only had one recurrence of polyp (5%). The p-value of 1.0 indicates no statistically significant difference between groups at this time. Conclusion: Postoperative oral Itraconazole therapy served as an adjunct, may play a role in significantly reducing recurrence in AFRS.