الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Allergic fungal sinusitis is a relatively newly characterized disease entity that commands a great deal of interest. Recent evidence supports the theory that allergic fungal sinusitis represents an immunologic, rather than infectious disease process.
An improved understanding of this underlying disease process has led to an evolution in the treatment of allergic fungal sinusitis.
Medical therapy has begun to shift from an emphasis upon systemic antifungal therapy to various forms of topical treatment and immunomodulation. Likewise, surgical treatment of allergic fungal sinusitis, still a crucial component of the overall treatment plan of the patient, has shifted from radical to a more conservative yet complete approach. Although important, surgery alone does not lead to a long-term disease free state. A comprehensive management plan incorporating both medical and surgical care remains the most likely way to provide long term disease control for allergic fungal sinusitis.
In this study, our aim was to evaluate the efficacy of one of the medical treatment options for allergic fungal sinusitis, which is systemic corticosteroids, to find an answer to our question, are systemic corticosteroids effective in the treatment of allergic fungal sinusitis or not ?
We performed a systematic review (using meta-analysis) of the published literature concerning the use of systemic corticosteroids in the management of allergic fungal sinusitis through searching the Medline data base (www.Pubmed.com).
Meta-analysis is a systematic approach to identify, appraise and synthesize, and (if appropriate) combine the results of relevant studies to arrive at conclusion.
Regarding the material of this study, search was done on 24/6/2009 using the following key words: (1) corticosteroids allergic fungal sinusitis, (2) steroids allergic fungal sinusitis, (3) endoscopic sinus surgery allergic fungal sinusitis.
The search was limited to the articles published in English language and performed on human subjects. It yielded a total number of 191 articles. After elimination of the duplicated articles we had a total number of 146 articles, of which there were 76 articles relevant to our study. Of these 76 articles, there were no randomized controlled trials; Only 20 articles were included in our study due to presence of all our inclusion criteria. Only one of them is a controlled trial and the remaining are retrospective studies or case series.
We pooled the data from these studies into the meta analytic rev man 5 software to get the result.
Our analytical study showed better results, and a significant improvement of patients with systemic corticosteroids as regard the recurrence rate when compared to patients that did not receive systemic corticosteroids. There is a highly significant difference in the recurrence rate of allergic fungal sinusitis between the 2 groups.
So we recommend the use of systemic corticosteroids for patients with allergic fungal sinusitis after endoscopic sinus surgery to prevent or minimize the recurrence.