Objectives: Allergic fungal rhinosinusitis (AFRS) has unique clinical symptoms, radiology, and histopathological patterns. It is easy to be misdiagnosed because of the low detection rate of fungi. The purpose of this study was to improve the diagnostic rate by analyzing these data of the clinical, radiology and pathological of AFRS. Methods: The data of patients with chronic rhinosinusitis (CRS) treated in the Department of Otolaryngology-Head and neck surgery of the First Affiliated Hospital of University of Science and technology of China (USTC) from January 2015 to December 2020 were analyzed. The discharged patients diagnosed with AFRS and the suspected cases in the description of radiology or surgical records were reviewed, combined with specific immunoglobulin E (IgE) examination, they were divided into three groups: AFRS, suspected AFRS and fungal ball sinusitis (FBS). The age, gender, eosinophils and basophils in peripheral blood, total serum IgE, invasion of sinuses, bone erosion, computed tomographic (CT) Lund-Mackay score, whether accompanied with allergic rhinitis, asthma, and olfactory hypothyroidism were all analyzed. Results: 631 patients with non-invasive fungal sinusitis were treated in the past 6 years. 29 cases of AFRS, 69 cases of suspected AFRS and 533 cases of FBS. A total of 98 confirmed and suspected AFRS cases were identified, with an average age of 34.3 years. 79 cases of multiple paranasal sinus invasion and 55 cases of bilateral paranasal sinuses. 25 cases with bone erosion. There were no significant differences in age, eosinophils percentage, basophils percentage, total serum IgE, CT Lund-Mackay score, combined with allergic rhinitis, asthma and hypoolfactory between AFRS and suspected AFRS. However, significant differences were observed in the above indicators between AFRS or confirmed AFRS and FBS. Conclusion: AFRS may be misdiagnosed due to the low detection of fungi. Clinical, laboratory, radiology and histopathological need to focus on improving the detection rate of fungi in AFRS. In order to reduce the recurrence of the disease, we can consider the diagnosis of AFRS for patients with clinical, radiology and immunological characteristics consistent with AFRS but without fungal etiology