Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies

Area of Science:

• Medical Mycology
• Otolaryngology
• Pathology

Background:

• Fungal rhinosinusitis presents diverse immune responses but lacks standardized terminology and classification.
• Optimal management strategies remain debated, necessitating expert consensus.

Purpose of the Study:

• To establish consensus on terminology and disease classification for fungal rhinosinusitis.
• To refine definitions for various forms of fungal rhinosinusitis, including invasive and allergic types.

Main Methods:

• Convened a working group under the International Society for Human and Animal Mycology.
• Reviewed existing literature and clinical observations to propose standardized terms and classifications.

Main Results:

• Recommended 'rhinosinusitis' over 'sinusitis' and defined terms like acute invasive fungal rhinosinusitis and chronic invasive rhinosinusitis.
• Proposed 'fungal ball' and 'localized fungal colonization' for specific presentations, and preferred 'eosinophilic mucin' over 'allergic mucin.'

Conclusions:

• Established a proposed schema for subclassifying fungal rhinosinusitis entities, including aspirin-exacerbated rhinosinusitis.
• Highlighted the need for precise visualization of fungal hyphae in eosinophilic mucin for accurate classification.
• Identified key research avenues to further refine understanding and management of fungal rhinosinusitis.