The Etiology of Chronic Rhinosinusitis Remains Unclear

Dr. Wang noted that treatment for each individual patient with CRS can be tailored to target the etiology of the disease. For instance, some patients need desensitization to fungi, aspirin, or other allergens, she said. Some patients may need oral, intravenous, or topical antibiotics, whereas others need surgery, and many patients need both approaches.

She also finds environmental as well as psychological and mental factors to be important modulators of the immune system that should be addressed. CRS patients are usually counseled to avoid environmental triggers such as mold, mildew, dust, pollens, and smog, if possible. This means maintaining as clean a house as possible, staying indoors on high smog and pollen days, and sometimes even moving to a different location, she said. In addition, stress management and lifestyle modification through healthy diet and exercise are important in maintaining a strong and balanced immune system, she said.

If fungus is a cause of CRS, antifungal therapy may be effective, said Dr. Ponikau. In one open-label pilot study conducted by Dr. Ponikau and his colleagues, amphotericin B (SinuNase, Accentia Biopharmaceuticals) improved symptoms in 75% of 51 patients with CRS. Endoscopically, 18 (35%) became disease-free. CT scans before and after treatment demonstrated a significant reduction in inflammatory mucosal thickening in the paranasal sinuses. Further, in a randomized, placebo-controlled, double-blind, single-center trial of 30 patients, Dr. Ponikau and his colleagues found that intranasal amphotericin B reduced inflammatory mucosal thickening on both CT scan and nasal endoscopy and decreased the levels of intranasal markers for eosinophilic inflammation in patients with CRS.

Based on these data, the drug’s manufacturer is preparing to commence its Phase III double-blinded, placebo-controlled clinical trial with amphotericin B to treat post-surgical patients suffering from recurrent CRS. The FDA has granted fast track status for the approval process. Accentia obtained exclusive worldwide rights to market and sell products based on Mayo Clinic’s patented treatment method using amphotericin B.

Topical amphotericin B nasal spray did not prove to be beneficial in a controlled double-blind study, noted Dr. Bernstein.

Although current therapies are limited, treatment of CRS will change dramatically as researchers continue to better understand the causes of disease, concluded Dr. Palmer.

©2006 The Triological Society