PubMed: Allergic fungal sinusitis study

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Curr Opin Otolaryngol Head Neck Surg. 2005 Feb;13(1):2-8.

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New paradigm for the roles of fungi and eosinophils in chronic rhinosinusitis.

Sasama J, Sherris DA, Shin SH, Kephart GM, Kern EB, Ponikau JU.

Department of Otorhinolaryngology, Mayo Clinic Rochester, Rochester, Minnesota

55905,

USA. sasama.jan@...

PURPOSE OF REVIEW: Chronic rhinosinusitis represents a challenge with its poorly

understood pathophysiology and limited treatment options. Potential roles of

fungi and

eosinophils in the etiology and pathophysiology of chronic rhinosinusitis are

summarized.

RECENT FINDINGS: Previously, the fungal role in chronic rhinosinusitis was

limited to the

rare subgroup, allergic fungal rhinosinusitis. Critical examination of earlier

diagnostic

criteria for allergic fungal rhinosinusitis reveals limitations. By using

updated diagnostic

standards and novel sensitive techniques to detect fungi, a higher number of

patients can

now be diagnosed with fungal rhinosinusitis. A novel non-IgE-mediated

immunologic

mechanism in chronic rhinosinusitis patients links the predominant eosinophilic

inflammation to certain fungi. Overall, these new findings have implications for

surgical

and medical approaches, including anti-inflammatory and antifungal medications.

SUMMARY: Several classification schemes and diagnostic criteria describe chronic

rhinosinusitis and make comparisons difficult. Preselection of patient groups

within the

chronic rhinosinusitis population and the lack of sensitive diagnostic

techniques have

prevented a full understanding of the syndrome complex of chronic

rhinosinusitis. New

results suggest a broader role for fungi in the pathophysiology of chronic

rhinosinusitis,

linking the eosinophilic inflammation to the presence of certain molds in the

nasal and

paranasal cavities. Although fungi are commonly found in nearly everyone, only

chronic

rhinosinusitis patients respond to them with an eosinophilic inflammation. These

findings

support a shift in the etiologic understanding of chronic rhinosinusitis away

from a

bacteriologic infectious pathogenesis to a fungal-driven inflammatory

pathophysiology.

Herein, the authors review earlier studies and describe an updated view on an

old

paradigm.