Personalized Surgery for Allergic Fungal Rhinosinusitis.

BACKGROUND: Allergic fungal rhinosinusitis (AFRS) frequently presents as unilateral or asymmetric disease. In cases with minimal disease on one side, the question remains as to the necessary extent of surgery. OBJECTIVE: To determine the relationship between symmetry and clinical characteristics in AFRS patients, with a focus on implications for surgical management. METHODS: Patients with AFRS managed surgically at the Medical University of South Carolina from 2012 to 2024 were reviewed. Disease severity was categorized by Lund-Mackay (LM) scoring system, as no/mild (LM < 4) or moderate/severe (LM ≥ 4) per side. Asymmetry was defined as a LM score difference of > 2 between sides. Extent of surgery was categorized as no/limited (< 2 sinuses) or extensive/full (> 2 sinuses) per side. Revision rates were compared by severity and extent of operation. RESULTS: There were 112 patients (224 sides) included in the study. The overall revision surgery rate was 16.9% (38/224), with no significant difference in recurrence between limited and extensive surgery among patients with no or mild disease (19.1% vs. 22.2%). Similarly, recurrence rates did not differ significantly between mild and moderate-severe disease in patients who underwent extensive surgery. Notably, recurrence was rare in sinuses without initial disease, and time to revision was longer following extensive surgery, though not statistically significant. CONCLUSION: Our analysis supports a stratified surgical approach, with conservative management appropriate for mild disease and extensive surgery yielding low recurrence in moderate-severe cases.