Atypical infections in chronic sinusitis: Thinking outside the box

A new research perspective was published in Oncoscience, titled "Think outside the box—atypical infections in chronic sinusitis."

Inflammations of the paranasal sinuses represent a common clinical picture. The annual prevalence of chronic sinusitis in Europe is up to 10%. Sinusitis can be divided into acute and chronic forms. In particular, the chronic forms (>12 weeks duration) are often challenging in the context of therapy.

Generally, all ventilation disorders of the paranasal sinuses (concha bullosa, nasal septal deviations, etc.,) represent risk factors for the development of any form of sinusitis. In addition, an immune deficiency or systemic diseases relevant to the immune system predispose to infections with atypical pathogens. Most sinusitis are caused by viruses, sometimes bacteria and, in rare cases, fungal infections. Furthermore, sinusitis can be differentiated with regard to the affected paranasal sinuses.

In addition to conservative treatment options for chronic sinusitis (glucocorticoid nasal sprays, antibiotics, antimycotics, immunotherapy), surgical procedures (functional endoscopic sinus surgery) can also be considered. However, chronic sinusitis tends towards a high rate of recurrences. Therefore, in many cases only symptom control is achieved.

In their recent research perspective, researchers Florian Dudde, Kai-Olaf Henkel and Filip Barbarewicz from the Department of Oral and Maxillofacial Surgery at Army Hospital Hamburg discuss treatment refractory forms of chronic sinusitis with unclear etiology. The authors note that these cases require interdisciplinary diagnostics and treatment, which they were able to demonstrate clearly in their recently published article.

"Fungal infections are a rare cause of sinusitis. A detailed anamnesis and clinical examination of the patient should be carried out, particularly in the case of therapy refractory forms of chronic sinusitis. It is also important to consider atypical causes and disease connections (root canal treatment, aspergilloma) when dealing with chronic sinusitis. Interdisciplinary diagnostics and therapy are crucial for the successful treatment of this rare entity," say the researchers.