Medical Paper Papers
1: Laryngoscope. 2003 Feb;113(2):264-9.
Eosinophilic fungal rhinosinusitis: a common disorder in Europe?
Braun H, Buzina W, Freudenschuss K, Beham A, Stammberger H.
University Ear, Nose and Throat Hospital, Auenbruggerplatz 26/28, 8036 Graz, Austria.
hannes.braun@kfunigraz.ac.at
OBJECTIVES/HYPOTHESIS: The traditional criteria for the diagnosis of allergic fungal
sinusitis include chronic rhinosinusitis, "allergic mucin" (mucuscontaining clusters
of eosinophils), and detection of fungi by means of histological examination or
culture. In 1999, a group of Mayo Clinic researchers, with a novel method of mucus
collection and fungal culturing technique, were able to find fungi in 96% of patients
with chronic rhinosinusitis. Immunoglobulin E-mediated hypersensitivity to fungal
allergens was not evident in the majority of their patients. Because the presence
of eosinophils in the allergic mucin, not a type I hypersensitivity, is probably
the common denominator in the pathophysiology of allergic fungal sinusitis, the
Mayo Clinic group proposed a change in terminology from allergic fungal sinusitis
to eosinophilic fungal rhinosinusitis. Using new techniques of culturing fungi from
nasal secretion, as well as preservation and histological examination of mucus,
we investigated the incidence of "eosinophilic fungal rhinosinusitis" in our patient
population. STUDY DESIGN METHODS: In an open prospective study nasal mucus from
patients with chronic rhinosinusitis as well as from healthy volunteers was cultured
for fungi. In patients, who underwent functional endoscopic sinus surgery, nasal
mucus was investigated histologically to detect fungi and eosinophils within the
mucus. RESULTS: Fungal cultures were positive in 84 of 92 patients with chronic
rhinosinusitis (91.3%). In all, 290 positive cultures grew 33 different genera,
with 3.2 species per patient, on average. Fungal cultures from a control group of
healthy volunteers yielded positive results in 21 of 23 (91.3%). Histologically,
fungal elements were found in 28 of 37 patients (75.5%) and eosinophilic mucin in
35 of 37 patients (94.6%). Neither fungi nor eosinophils were present in 2 of 37
patients (5.4%).
CONCLUSIONS: Our data show that the postulated criteria of allergic fungal sinusitis
are present in the majority of patients with chronic rhinosinusitis. Either those
criteria will be found to be invalid and need to be changed or, indeed, "eosinophilic
fungal rhinosinusitis" exists in the majority of patients with chronic rhinosinusitis.
Based on our results, fungi and eosinophilic mucin appear to be a standard component
of nasal mucus in patients with chronic rhinosinusitis.
PMID: 12567080 [PubMed - indexed for MEDLINE]
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