Focus Areas of Group

1. Prevalence of fungal rhinosinusitis among patients with chronic rhinosinusitis

-Population–based data
-Hospital-based data

2. Categorization of fungal rhinosinusitis

a) Does chronic destructive, non-invasive type exists as separate entity?
b) Is there any requirement of separation between granulomatous invasive and chronic invasive types?
c) Is there any subtype of granulomatous invasive type – chronic eosinophilic lypmhocytic granuloma exists?
d) Correct definition of AFRS
e) Does AFRS type lead to invasive type?
f) Whether these types are separate category of chronic fungal rhinosinusitis or a spectrum of single disease?

3. Etiological agents:

a) Listing and prevalence of spectrum agents in each category of fungal rhinosinusitis
b) Why A. flavus is common in Sudan, India, Pakistan and A. fumigatus in Europe and USA?
c) Is the agent causing infection in sinuses different from agent infecting other sites?
d) Molecular typing of A. flavus and A. fumigatus

4. Pathogenesis:

a) Role of local innate immunity
b) Virulence factors of etiological agents
c) Are fungi responsible for AFRS?
d) Role of anatomic alternation, zinc, previous bacterial or viral diseases in causation of fungal rhinosinusitis
e) Genetic risk factor analysis of fungal rhinosinusitis
f) Histopathology of different category of fungal rhinosinusitis
g) Refinement of animal experimental model

5. Management:

a) Algorithm in management of fungal rhinosinusitis
b) Role of radiology
c) Role of histopathology
d) Role of serology
e) Any role of PCR in diagnosis
f) Treatment protocol

I.  AFRS – steroid (oral/local spray), antihistaminics etc.
II. Granulomatous or chronic invasive type

i. Role of antifungal agents - dose and duration
ii. Long follow up

III. Fulminant type – ideal management protocol
IV. Role of surgery