Nasal fungi now the focus of sinusitis researchers
By Gabrielle Glaser
the New York Times
WASHINGTON - Scientists long thought that sinusitis, the most
common long-term disease in the United States, was caused by allergies
or by bacteria trapped inside the labyrinthine sinuses. Over the years,
doctors have tried a variety of treatments for chronic coldlike
symptoms with limited success.
Then last year, researchers at the Mayo
Clinic in Rochester, Minn., reported that they had found another
possible cause: an overly aggressive immune reaction to fungi in the
nose. "It is a total shift of the paradigm," said Dr. Jens Ponikau, one
of the Mayo researchers.
With new laboratory techniques, scientists have compiled a much
clearer picture of the organisms that grow in noses and sinuses, and the
pictures show that fungi are more prevalent than previously belived. In
addition, the researchers came up with a possible mechanism through which
the body's reaction to fungi causes the inflamation that fosters sinusitis
in some people.
The finding, if true, suggests the need for a different approach,
aimed at killing the fungi. The antihistamines that tamp down an allergic
person's response to a nose full of cat dander, pollen or dust mites appear
to have no effect on the stuffiness caused by the fungi.
At a rhinology conference Friday in Washington, the researchers
reported that they had tried a new treatment aimed at the fungi. Dr. David
Sherris, who conducted the three-month experiment, gave 51 patients with
chronic sinus inflammation an antifungal drug spray. Thirty-eight, or 75
percent, reported a reduction in symptoms, which researchers confirmed by
visual examination.
The research, Sherris said, suggests that the antifungal drugs may
eliminate the need for steroids. Sixteen of the patients who reported
improvement were taking steroids for the disease, and 13 of them were able
to reduce their dose or do without the drugs entirely.
The Mayo results have not been subjected to the most rigorous test, a
double-blind clinical study, although one is planned for this year.
Still, some experts at the conference were skeptical. "This isn't
a magic wand just yet, but it's a hopeful sign," said Dr. Jordan Josephson,
a Manhattan otolaryngologist.
Dr. David Kennedy, a professor of otolaryngology at the University
of Pennsylvania, also counseled caution. Chronic sinusitis, he said, is
caused by a variety of factors, including viruses, pollution, stress and
genetic disorders that make the sinuses function improperly.
The Mayo researchers do not disagree. They say their study is
applicable to many cases, not all. "We're not declaring victory just yet," Sherris
said.
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