title: Clinical presentation of allergic fungal sinusitis in children.
abstract: OBJECTIVE
  To compare the differences in the clinical and radiographic presentation of allergic fungal sinusitis in children and adults.
  
  
  METHODS
  Retrospective chart and computed tomography review.
  
  
  METHODS
  The settings included a tertiary care children's hospital, adult academic private hospital, and academic affiliated county hospital. All patients with documented allergic fungal sinusitis who underwent computed tomography evaluation and had surgical treatment of their disease from 1988 to 1999 were included in the study. In total, 151 patients aged 5 to 75 years; 44 of these patients were less than or equal to 17 years of age (children) and 107 were greater than 17 years of age (adults). Main outcome measures included 1) the presence of obvious bony facial abnormalities on presentation, 2) bilateral or unilateral sinus disease on presentation, 3) the presence of asymmetrical disease on presentation, 4) the presence of bony extension on computed tomography scan, and 5) type of fungus present.
  
  
  RESULTS
  Fifteen of 36 (42%) pediatric patients and 10 of 103 (10%) adult patients had obvious alteration of their facial skeleton (proptosis, telecanthus, or malar flattening) on presentation (P <.05). Proptosis was the most common facial abnormality in both groups and was seen more often in children (8 of 36 [22%]) than in adults (9 of 103 [9%]) (P <.05). Twenty-eight of 40 (70%) pediatric patients and 37 of 100 (37%) adult patients presented with unilateral sinus disease (P <.05). Thirty-five of 40 (88%) pediatric patients and 58 of 100 (58%) adults presented with asymmetrical disease (P <.05). Computed tomography scans showed that 10 of 40 (25%) pediatric patients and 23 of 100 (23%) adult patients had bony erosion with extension of disease into surrounding structures (P >.05). Cultures from both adults and children showed mainly Bipolaris and Curvilaria species in equal amounts (P >.05). Adults had a greater incidence of Aspergillus species.
  
  
  CONCLUSIONS
  Presentation in pediatric patients with allergic fungal sinusitis is different from that in adults, with children having obvious abnormalities of their facial skeleton, unilateral sinus disease, and asymmetrical disease more often. Findings on computed tomography scan show an equal amount of bony erosion with extension of disease. The types of fungus cultured in the sinus cavities are similar in both groups.
authors.affiliation: Department of Otolaryngology--Head and Neck Surgery, University of Texas at Southwestern Medical Center, Dallas 75390-9035, USA. Jmccla@mednet.swmed.edu
authors.forename: John E
authors.initials: JE
authors.lastname: McClay
authors.forename: Brad
authors.initials: B
authors.lastname: Marple
authors.forename: Lav
authors.initials: L
authors.lastname: Kapadia
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Biavati
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
authors.forename: Mark
authors.initials: M
authors.lastname: Newcomer
authors.forename: Scott
authors.initials: S
authors.lastname: Manning
authors.forename: Tim
authors.initials: T
authors.lastname: Booth
authors.forename: Nathan
authors.initials: N
authors.lastname: Schwade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005147:Facial Bones / Q000473:pathology; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed