The role of fungi in the airway of chronic rhinosinusitis patients.

PURPOSE OF REVIEW: To analyze the role of fungi in the upper and lower airway in chronic rhinosinusitis patients. RECENT
FINDINGS: Recently, the involvement of the lower airway (as asthma, small airway disease and bronchial hyperresponsiveness) in chronic rhinosinusitis patients had been documented. Fungal spores after inhalation are submerged in the aqueous lining layers of the airway. The site depends on the size of the inhaled spores. The process of inhalation, retention and clearance of fungal spores may explain the positive culture results in both normal subjects and in most chronic rhinosinusitis patients. Fungal culture of different parts of the upper and lower airway in chronic rhinosinusitis patients had no correlation with cellular changes (local eosinophilia) and other clinical parameters. In chronic rhinosinusitis, with persistence of the chronic inflammatory process, the cells may be activated nonspecifically.
SUMMARY: The role played by fungi in most chronic rhinosinusitis patients as the target antigen of initiation of such chronic inflammation is still debated. With the presence of chronic eosinophilic inflammation in chronic rhinosinusitis, an exaggerated reaction to various inhaled antigens is anticipated. The role of fungi will be confirmed only when T cells within the sinuses are shown to be actively responding to fungal antigens cultured from the sinus and with the demonstration that their elimination will stop the disease.