Oral and Topical Antifungals

Abstract

The role of fungi in various forms of CRS remains to be defined. Although different studies have agreed that fungi can be detected in the nose and paranasal sinuses of nearly all CRS patients, they are present in healthy controls as well. Fungus is likely to be causal in invasive disease (acute invasive fungal rhinosinusitis and chronic invasive fungal rhinosinusitis) and might play a role in noninvasive disease (localized fungal colonization, fungal ball, and allergic fungal rhinosinusitis). The immunocompetence of the patient is of great importance, as invasive fungal rhinosinusitis is usually found in immunosuppressed patients. Systemic antifungal agents are, together with surgery, a fundamental component in the treatment of invasive forms. Antifungal drugs and immunotherapy may have a role as adjuvant therapy in allergic fungal rhinosinusitis, but evidence is poor to support recommendations. There is no indication for antifungal treatment in CRS with or without nasal polyps.