ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Fungal Theory Debated in Amphotericin B Controversy

by Sue Pondrom • March 1, 2008

  • Tweet
  • Email
Print-Friendly Version

We think there are several implications of this study, Dr. O’Donnell told ENT Today. Assuming that unblinding confirms our interpretation of the blinded data, a fungal-induced inflammation as the cause of chronic sinusitis is a valid paradigm. It’s a host-defined disease where only 10 percent of those exposed to fungi mount an inflammatory response characterized by eosinophils.

You Might Also Like

No related posts.

Explore This Issue
March 2008

He added that Mayo was right. A topical intranasal administration of extremely low doses of antifungals looks like it will be significantly effective at reducing the symptoms and inflammatory changes in the nose and in the sinuses. The clinical trial is suggesting that the vast majority of bona fide CRS cases are due to the fungal-induced inflammation. Although patients in the Phase III study were not selected on the basis of whether or not they had nasal mucin that was positive for eMBP, after enrollment, every patient has tested positive so far for eMBP.

Jens Ponikau, MD

Jens Ponikau, MD

Clearly, the results are incompatible with what was shown by Weschta and Ebbens, Dr. O’Donnell further stated, noting that the studies by the European researchers showed no effect on symptoms or signs, whereas the Accentia trial with 302 patients indicates at the still-blinded point that roughly half of the patients have a significant resolution-not just a reduction in severity-of symptoms and improvement in endoscopy and CT scans of the sinuses.

Dr. Ebbens cautioned, however, that the Accentia results may reflect a placebo effect. Before drawing any conclusions, we should await the unblinded results, she said.

This is the first time that anything for CRS has made it into an FDA-approved Phase III trial, Dr. Ponikau said. No drug or treatment has ever gone that far for CRS. We are careful in what we are saying; we’re saying it’s in development and we’re learning a lot about it, but we’re not there yet.

A lot of patients are going to benefit from the research at the Mayo Clinic, Dr. O’Donnell added. But that research met with incredible skepticism because many people failed to understand what Mayo was saying. They weren’t saying that if you had the fungus, you had the disease. Rather, they were saying it’s a host-defined disease. Virtually everyone has the fungus in the mucus of their nose and sinus. But only 10 percent of the population has an inflammatory response to it.

Maybe Not for Everyone

Neil Bhattacharyya, MD, Associate Professor of Otolaryngology at Brigham and Women’s Hospital and Harvard Medical School in Boston, would agree, but with a caveat. He said, Amphotericin B is one of the members of our armamentarium that we use to treat chronic rhinosinusitis-in certain cases. I think it has a role in the treatment of a certain subset of CRS, but it’s not, in my opinion, going to be the end-all, be-all answer for why those patients don’t do well with traditional therapy or surgery.

Pages: 1 2 3 4 5 6 | Single Page

Filed Under: Allergy, Departments, Medical Education, Practice Focus, Rhinology Tagged With: allergic sinusitis, CT, debate, fungus, medication, research, rhinosinusitis, Sinusitis, treatmentIssue: March 2008

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Some Studies Predict a Shortage of Otolaryngologists. Do the Numbers Support Them?
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • Complications for When Physicians Change a Maiden Name
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • Tympanoplasty Tips: Otology Experts Give Advice on the Procedure
    • How Treatment for Obstructive Sleep Apnea (OSA) Is Evolving to Give Patients a Better Night’s Sleep
    • Vestibular Schwannoma Position Relative to Internal Auditory Canal Helps Predict Postoperative Facial Function
    • Vocal Fold Lipoaugmentation Provides Long-Term Voice Improvements for Glottal Insufficiency
    • Upper Lateral Cartilage Mucosal Flap Enables the Successful Closure of Larger Septal Perforations

Polls

Do you think there will be a shortage of otolaryngologists in the next five to 10 years?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2022 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.