AFAIK, the only treatments for Allergic Fungal Sinusitis are topical
antifungals like amphotericin B irrigation and Sporonox irrigation.

 I totally agree with the statement about many ENTS minimizing the
symptoms of sinusitis, period, or even admiting it is there without
definite radiological evidence, which most of the time is "limited CT
scans."  I even went to National Jewish Medical Center (ranked the # 1
respiratory hospital in the world) and had a CT scan that showed "mild"
chronic ethomoid sinusitis with possible osteomyelitis and was just
told to use Flonase twice a day.   Nobody even mentioned the
possibiltiy of bone infection.  I only found out when asking for
records.  I've been to a few ENTs in my hometown and told I didn't have
sinusitis because they didn't see anything at the time of the exam.
Then I could go home and wash tons of junk out of my head, but because
they didn't see it at the time, it wasn't there.

  After 6 months of total misery and pain behind my nose so bad I had
to get a morphine shot in the ER to stop the pain for a while, then use
Lortabs,  I was finally diagnosed with allergic fungal sinusitis and
osteomyelitis by an infectious doctor who treats difficult to treat
sinusitis.  He subcribes to the Mayo theory of fungi being the
underlying problem in many cases.   I'm not sure if he feels it is in
all cases.  His theory says that it is due to an abnormal immune
response to the molds which is probably genetic.  This sets up the
"climate" for bacterial infections.  Molds are sometimes very difficult
to culture from the sinuses;  I've had several cultures done, and it
has only shown up when sent to a specific lab that only cultures mold.)
   I am on IV Vfend (voriconazole) and am slowly making progress. My
situation is a little bizarre, and hopefully noone will have to take
these drastic measures, but it just shows how so many doctors don't
listen to their patients.
   I might add that other doctors think that AFS should be treated
with steroids, but it only made my situation worse.  But then I have an
actual fungal infection going on too, which I think I got from not
being properly diagnosed and treated to begin with.

Regards,
Kathy

The thing that has helped the most is daily fluconazole (Diflucan); I
have been taking it for several years.  You have to get a monthly blood
test to make sure your liver can handle the medication. Irrigation with
Sporanox solution has also helped me (I couldn't tolerate the Ampho-B)
and I also noticed a significant difference when I started taking
Singulair (I also take Allegra but I don't think it does anything).  I
also get allergy shots; not sure if it helps with the AFS but it has
helped with other allergies.

I never did get a positive mold culture; diagnosis was made by
symptoms, strong allergy to molds, and positive response to
fluconazole.  I also never got any help at all from ENT's (three of
them); one ENT, a specialist at a famous medical center, told me he
thought I needed a vacation! I responded that I had unfortunately had
to cancel my long-planned vacation because I was too sick to go.

I had to find an allergist who specialized in chronic sinusitis before
I got an accurate diagnosis.   The first allergist I saw told me to
just keep doing what I was doing (allegra and nasal steroids, at that
time)

Good luck; hopefully medical research will come up with more
satisfactory treatments before we're too old to benefit!