Antifungal Treatment (Topical/Systemic)

The exact origin of chronic rhinosinusitis (CRS) is still unknown. The disease is most likely to be caused and maintained by multiple factors. A recent theory suggested fungi to be significantly implicated in the generation of CRS and nasal polyposis (NP). Preliminary reports suggested that topical antifungal treatment improved NP and CRS, whereas randomized, blinded, and placebo-controlled trials did not find antifungal lavages or sprays to be better than saline. Similarly, systemic antifungal treatment did not show any effect on CRS. Despite disappointing clinical trials, there is evidence that amphotericin B efficacy (a) depends upon the dosage and duration used and (b) probably acts via a selective cytotoxic effect on NP cells, rather than its antifungal properties. Whatever the future of amphotericin B in rhinology, one must not forget that this drug has side effects and that extensive use might induce resistances.