Related Experiment Video
Updated: May 30, 2026
Acupoint Catgut Embedding Therapy in Traditional Chinese Medicine for Managing Allergic Rhinitis
Published on: December 20, 2024
Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis
Peta-Lee Sacks1, Richard J Harvey, Janet Rimmer
1St Vincent's Clinical School, St Vincent's Hospital, 806/438 Victoria St, Darlinghurst, Sydney, Australia, NSW 2010.
Background:
Chronic rhinosinusitis (CRS) is an inflammatory disorder of the nose and sinuses. Since fungi were postulated as a potential cause of CRS in the late 1990s, there has been increasing controversy about the use of both topical and systemic antifungal agents in its management. Although interaction between the immune system and fungus has been demonstrated in CRS, this does not necessarily imply that fungi are the cause of CRS or that antifungals will be effective its management.
Objectives:
To assess the effectiveness of topical or systemic antifungal therapy in the treatment of CRS.
Search Strategy:
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 8 March 2011.
Selection Criteria:
All randomised, placebo-controlled trials considering the use of topical or systemic antifungal therapy in the treatment of CRS and allergic fungal sinusitis (AFS). CRS was defined using either the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) or American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) criteria.
Data Collection And Analysis:
We reviewed the titles and abstracts of all studies obtained from the searches and selected trials that met the eligibility criteria. We extracted data using a pre-determined data extraction form. There was significant heterogeneity of outcome data reporting with reports containing both parametric and non-parametric representations of data for the same outcomes. Means and standard deviations for change data were unavailable for a number of trials. Due to the limited reported data, we contacted authors and used original data for data analysis.
Main Results:
Six studies were included (380 participants). Five studies investigated topical antifungals and one study investigated systemic antifungals. The risk of bias in all included studies was low, with all trials being double-blinded and randomised. Pooled meta-analysis showed no statistically significant benefit of topical or systemic antifungals over placebo for any outcome. Symptom scores in fact statistically favoured the placebo group. Adverse event reporting was statistically significantly higher in the antifungal group.
Authors' Conclusions:
On the basis of this meta-analysis, there is no evidence to support the use of either topical or systemic antifungal treatment in the management of CRS.
Insights
Antifungal treatments for chronic rhinosinusitis (CRS) show no benefit over placebo. This meta-analysis found no evidence supporting the use of topical or systemic antifungals for CRS management, with higher adverse events reported in the antifungal group.
Area of Science:
- Otolaryngology
- Immunology
- Mycology
Background:
- Chronic rhinosinusitis (CRS) is a common inflammatory condition affecting the nose and sinuses.
- The role of fungi in CRS pathogenesis has been debated since the late 1990s.
- Controversy exists regarding the efficacy of antifungal therapies in CRS management.
Purpose of the Study:
- To evaluate the effectiveness of topical or systemic antifungal therapy for treating CRS.
- To synthesize evidence from randomized, placebo-controlled trials on antifungal use in CRS.
Main Methods:
- Comprehensive literature search of multiple databases including Cochrane, PubMed, EMBASE, and Web of Science.
- Inclusion criteria focused on randomized, placebo-controlled trials of topical or systemic antifungals for CRS and allergic fungal sinusitis (AFS).
- Data extraction and analysis were performed, addressing heterogeneity and contacting authors for missing data.
Main Results:
- Six double-blind, randomized trials involving 380 participants were included.
- Pooled meta-analysis revealed no statistically significant benefit of antifungal therapy (topical or systemic) compared to placebo.
- Symptom scores favored the placebo group, and adverse events were significantly higher in the antifungal group.
Conclusions:
- Current evidence does not support the use of topical or systemic antifungal treatments for chronic rhinosinusitis.
- The findings suggest that antifungal therapy is not an effective management strategy for CRS.
- Further research may be needed to clarify the role of fungi in CRS and alternative treatment approaches.
Related Concept Videos
01:27Cryptococcal Meningitis
01:16Drugs Used in Upper Respiratory Disorders: Overview
Antihistamines (e.g., Benadryl) block histamines from binding. Histamines are chemicals released during an allergic reaction in the body. As a...
01:15Antifungal Agents
01:24Cystic Fibrosis: Management
Sinus disease and chronic sinusitis...
01:30Epistaxis
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...