Bone erosions are common in allergic fungal rhinosinusitis (AFRS). This study aimed at developing an image-based grading and scoring system for paranasal sinus (PNS) wall erosion in AFRS. A retrospective review of all confirmed AFRS cases based on the Bent and Kuhn criteria was conducted. Preoperative computed tomography (CT) images were studied to detect PNS wall erosion with expansion. Based on our observation, we described a grading system based on the proportion of PNS wall erosion, with 1 if less than one-third, 2 if between one-third and two-thirds, and 3 if more than two-thirds of the wall is eroded. This method provides a new scoring system ranging from 0 to 72. The inter-observer reliability of this scoring system was tested and the percent of agreement was found to be 90%. Among 142 AFRS cases, 82 patients (57.7%) had bone erosion. Orbital extension via lamina papyracea erosion occurred in 28.2% and 17.6% of the anterior and posterior ethmoid sinuses respectively, via floor erosion in 8.3% of the frontal sinuses, and via roof erosion in 2.1% of the maxillary sinuses. Intracranial extension caused by the anterior skull base erosion occurred in 19.4%, 10.9%, and 6% of the posterior ethmoid, anterior ethmoid, and frontal sinuses, respectively. The middle and posterior cranial fossa skull base was eroded in 14.4% and 9.2% of the sphenoid sinuses, respectively. Infratemporal extension occurred via erosion of the sphenoid sinus lateral wall in 17.3% of the sphenoid sinuses and via erosion of the maxillary sinus posterior wall in 6.7% of the maxillary sinuses. The mean of bone erosion score was 9.52, and the highest score was 34/72. The orbit is the most common extra-sinus extension site via the lamina papyracea erosion. We propose a new grading and scoring system to assess disease severity and progress.

Hemangioma is a frequently observed soft tissue tumor that can be classified into cavernous, capillary, and venous subtypes. It occurs frequently in the head and neck; however, with rare reports of hemangiomas in the external auditory canal (EAC). The present study describes the case of a 57-year-old male patient who presented to our center with a subsequent diagnosis of capillary hemangioma of the EAC. The entire lesion was surgically removed, with no evidence of recurrence on the subsequent follow-up.

Background: Bone erosion is a feature of allergic fungal rhinosinusitis (AFRS). The incidence of bone regeneration after treatment is unknown. The objective of this study is to evaluate the fate of bone erosion in AFRS. Materials and methods: A retrospective chart review was conducted for all AFRS patients who had preoperative evidence of bone erosion on the computed tomography (CT) of the paranasal sinus (PNS) and at least one postoperative image. We used the bone erosion score (BES) as a valid tool to evaluate the preoperative bone erosion extension and the rate of regeneration on postoperative images. Results: A total of 40 patients met our enrollment criteria. Of these, 30 patients underwent CT within nine months postoperatively (mean baseline BES: 9.07, SD: 8.11), 33 patients underwent CT between nine and 18 months postoperatively (mean baseline BES: 9.36, SD: 8.80), and 34 patients underwent CT after 18 months postoperatively (mean baseline BES: 8.56, SD: 7.69). The BES improved by 88.92% within nine months postoperatively with a follow-up BES of 0.93 (SD: 1.65), by 90.29% between nine and 18 months with a follow-up BES of 0.91 (SD: 2.15), and by 96.57% after 18 months with a follow-up BES of 0.29 (SD: 0.62). Complete bone regeneration occurred in 27 patients (67.50%); this was noted within nine months in 21 patients and after 18 months in six. Among them, 16 were male and 11 were female (p = 0.75). Regarding their ages, eight were pediatric and 19 were adult patients (p = 0.31). Conclusion: Bone erosion in AFRS is a mostly reversible process. Complete bone regeneration occurred in more than two-thirds of patients within a short period of time.