Allergic Fungal Rhinosinusitis Clinical Management: From Clinic to Operating Room

PROGRAM DESCRIPTION: Allergic Fungal Rhinosinustis (AFRS) is a severe subtype of Chronic Rhinosinusitis with nasal polyps characterized by thick eosinophilic mucin containing fungal hyphae. Practitioners face several challenges treating AFRS:
- Heterogeneous clinical presentation
- Rapid recurrence in mucin and polyps in >50% of patients
- Frequent advanced disease at presentation with bony erosion/destruction
- Mass effect on the orbit or intracranial space, which can cause erroneous concern for tumors when improperly imaged
Additionally, the impact of social determinants of health has an important role in the development of this disease. The panelists have published and unpublished data that indicates that this disease disproportionately impacts racial and ethnic minorities and those of lower socioeconomic status.
This panel will guide practitioners through these challenges to perform appropriate work-ups and develop and provide the best clinical management for AFRS.

Goals: The panel will build on last year's presentation by providing an overview of the updates in our understanding of AFRS, including high-risk populations and geographic locations. We will review the challenges with the classic diagnostic criteria and appropriate workup for AFRS + AFRS-like variants. The panel will place particular emphasis on an interactive discussion of the clinical management of AFRS using case examples. Through the cases, we will review how to determine the timing of medical, surgical, and adjunctive treatments, including use of biologics. We will discuss potential complications and how to avoid them. The panel will discuss new published and unpublished data on AFRS clinical management, pathophysiology, and health disparities.

Target Audience: This panel is designed for a general otolaryngology audience in order to give a comprehensive overview of our current AFRS knowledge and review the options for the best clinical practice management.

OUTCOME OBJECTIVE 1: Discuss updates in the pathophysiology, epidemiology, diagnosis of Allergic Fungal Rhinosinusitis (AFRS) and review the role of medical and biologic medication in the treatment of AFRS

OUTCOME OBJECTIVE 2: Review cases to highlight standard and cutting-edge medical and allergy treatment options and discuss the timing of in-office procedures and surgical intervention for AFRS

OUTCOME OBJECTIVE 3: Discuss new clinical and translational research and how it impacts clinical care for AFRS


BACKGROUND STATEMENT: Advances in our knowledge about AFRS pathophysiology, cutting-edge allergy/biologic treatments, and the longitudinal trajectory of disease have changed our approach to AFRS over the past decade. The importance of a multi-pronged approach that includes allergy and rhinology is emphasized.

Comprehensive Otolaryngology Track Statement :