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Fungal rhinosinusitis: what every allergist should know
1Otorhinolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile.
Summary
Fungal rhinosinusitis encompasses non-invasive and invasive diseases, requiring tailored treatment. Diagnosis combines clinical, lab, and imaging data, with surgery and antifungals crucial for invasive forms.
Area of Science:
- Otolaryngology
- Mycology
- Immunology
Background:
- Fungal infections of the sinonasal tract present a wide range of clinical presentations and complexities.
- Existing classifications of fungal rhinosinusitis are intricate, necessitating a simplified approach for clarity.
Purpose of the Study:
- To rationalize and simplify the classification of fungal diseases affecting the nose and paranasal sinuses.
- To review current literature on the diagnosis and management of fungal rhinosinusitis, highlighting key aspects for immunologists and allergists.
Main Methods:
- Review of current literature on fungal rhinosinusitis.
- Classification into non-invasive (localized colonization, fungal ball, allergic fungal rhinosinusitis) and invasive (acute, chronic, granulomatous) disease.
- Emphasis on diagnostic methods including history, examination, lab tests, imaging, and histopathology.
Main Results:
- Diagnosis relies on a combination of clinical findings and investigations.
- Patient immunocompetence is critical; invasive disease is rare in immunocompetent individuals.
- Treatment strategies differ significantly between non-invasive and invasive forms, with surgery being primary for most types and systemic antifungals essential for invasive disease.
Conclusions:
- Fungal rhinosinusitis requires a structured diagnostic and management approach.
- Surgical intervention is central to treating most fungal rhinosinusitis, except for localized colonization.
- Further research, including randomized controlled trials, is needed to validate immunotherapy and adjuvant antifungal therapies for allergic fungal rhinosinusitis.
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