Affecting more than 30 million Americans, chronic rhinosinusitis (CRS) has been a frustrating disease with no long-lasting results from traditional steroidal and antibiotic treatment, or from surgery. With both clinicians and patients desperate for a solution, it is not surprising that hope-and controversy-has arisen over a potential new therapy.
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March 2008The use of the antifungal agent amphotericin B to treat noninvasive fungi in CRS has become one of otolaryngology’s hot-button issues. Even though the National Institutes of Health (NIH) announced in a 2004 press release that people with chronic sinus inflammation have an exaggerated immune response to common airborne fungi, many in the medical community are hesitant to embrace an antifungal, one-size-fits-all treatment for all CRS patients.
The concept is that airborne fungi gather in the nose and sinuses and are attacked by eosinophils, which produce secondary mucosal inflammation in susceptible individuals. The debate regards the link between these fungi and CRS. Most specialists regard allergic fungal sinusitis (AFS) as a subset of chronic rhinosinusitis (CRS), which has been defined as any inflammatory disease of the nose and paranasal sinuses that lasts longer than three months. Traditionally, the opinion was that AFS consists of fungus within the sinuses and allergy to that fungus. However, studies in recent years suggest that conventional allergy does not matter-that the immune response to fungi may be mediated through a lymphocyte-dependent mechanism independent of an immunoglobulin E (IgE)-mediated allergy.