Itraconazole versus steroids in post operative cases of allergic fungal rhinosinusitis: a randomized controlled trial

This study was aimed to compare the effect of oral steroids and itraconazole in reducing the recurrence in allergic fungal rhinosinusitis (AFRS) patients undergoing ESS. In this randomized controlled trial, 50 patients of both sexes aged between 15-60 years with AFRS were subjected to functional endoscopic sinus surgery (ESS). In the post-operative period, patients were randomly divided into 2 groups containing 25 patients each. Group A received systemic steroid followed by topical steroid. Group B received oral itraconazole. Patients were followed at the end of 6, 10 and 14 weeks after surgery. Sinonasal outcome test 22 (SNOT-22) Lund Kennedy endoscopic score (LKES), AEC and serum total IgE were repeated at each post-operative visit and compared with the preoperative values. Repeat NCCT nose and PNS was done at 14th week to look for recurrence. Statistically significant difference was seen between the two groups in AEC, LKES and SNOT-22 with group A showing more significant improvement than group B, but not in serum IgE and Lund Mackay computed tomography (LMCT) score. The group A had 24% (n=6) recurrence rate, while group B had 44% (n=11) recurrence rate. The difference in the two groups in recurrence was not statistically significant. We evaluated multiple parameters including radiological and endoscopic scores to find the difference between the two drugs and found steroid to be superior than itraconazole.