European Archives of Oto-Rhino-Laryngology

, Volume 265, Issue 4, pp 415–419 | Cite as

Rate of allergic fungal etiology of chronic rhinosinusitis in Turkish population

  • Yusuf Hidir
  • Fuat Tosun
  • Mehmet Ali Saracli
  • Armagan Gunal
  • Mustafa Gulec
  • Sertac Yetiser


The aim of this study is to investigate intranasal fungal incidence in Turkish patients with chronic rhinosinusitis (CRS). One hundred patients with CRS and 40 healthy subjects as a control group were included in the prospective study. Nasal lavage samples were investigated for the presence of fungus, using new culture techniques and histopathologic examination. Epidermal and intradermal hypersensitivity tests were used to find out fungal atopy. Levels of serum eosinophils, total IgE and presence of fungus-specific IgE were investigated in the blood samples. Quantitative parameters were analyzed using Pearson χ2 test. Allergic fungal sinusitis (AFS) was diagnosed in 13(13%) patients. There was no fungal growth in the control group. Eosinophilic mucin was detected in 94% of patients. Clinical and laboratory parameters of CRS were not significantly different in patient groups with or without intranasal fungi. As a result, fungal incidence was not as high as expected in Turkish patients with CRS. Furthermore, no significant correlation could be found between presence of intranasal fungus and type-1 hypersensitivity in patients with CRS.


Rhinosinusitis Fungi Allergy 


  1. 1.
    Braun H, Buzina W, Freudenschuss K, Beham A, Stammberger H (2003) Eosinophilic fungal rhinosinusitis: a common disorder in Europe? Laryngoscope 113(2):264–269PubMedCrossRefGoogle Scholar
  2. 2.
    Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW, Lanza DC, Marple BF, Osguthorpe JD, Stankiewicz JA, Anon J, Denneny J, Emanuel I, Levine H (2003) Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 129(3):1–32CrossRefGoogle Scholar
  3. 3.
    Bent JP 3rd, Kuhn FA (1996) Antifungal activity against allergic fungal sinusitis organisms. Laryngoscope 106(11):1331–1334PubMedCrossRefGoogle Scholar
  4. 4.
    Bent JP 3rd, Kuhn FA (1994) Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg 111(5):580–588PubMedCrossRefGoogle Scholar
  5. 5.
    Catten MD, Murr AH, Goldstein JA, Mhatre AN, Lalwani AK (2001) Detection of fungi in the nasal mucosa using polymerase chain reaction. Laryngoscope 111(3):399–403PubMedCrossRefGoogle Scholar
  6. 6.
    Collins M, Nair S, Smith W, Kette F, Gillis D, Wormald PJ (2004) Role of local immunoglobulin E production in the pathophysiology of noninvasive fungal sinusitis. Laryngoscope 114(7):1242–1246PubMedCrossRefGoogle Scholar
  7. 7.
    deShazo RD, Chapin K, Swain RE (1997) Fungal sinusitis. N Eng J Med 337(4):254–259CrossRefGoogle Scholar
  8. 8.
    Dhiwakar M, Thakar A, Bahadur S, Sarkar C, Banerji U, Handa KK, Chhabra SK (2003) Preoperative diagnosis of allergic fungal sinusitis. Laryngoscope 113(4):688–694PubMedCrossRefGoogle Scholar
  9. 9.
    Goh BS, Gendeh BS, Rose IM, Pit S, Samad SA (2005) Prevalence of allergic fungal sinusitis in refractory chronic rhinosinusitis in adult Malaysians. Otolaryngol Head Neck Surg 133(1):27–31PubMedCrossRefGoogle Scholar
  10. 10.
    Hafidh M, Harney M, Kane R, Donnelly M, Landers R, Smyth D (2007) The role of fungi in the etiology of chronic rhinosinusitis: a prospective study. Auris Nasus Larynx 34:185–189PubMedCrossRefGoogle Scholar
  11. 11.
    Kostamo K, Richardson M, Malmberg H, Ylikoski J, Ranta H, Toskala E (2005) Does the triad of fungi, bacteria and exposure to moisture have an impact on chronic hyperplastic sinusitis? Indoor Air 15(2):112–119PubMedCrossRefGoogle Scholar
  12. 12.
    Kuhn FA, Swain R Jr (2003) Allergic fungal sinusitis: diagnosis and treatment. Curr Opin Otolaryngol Head Neck Surg 11(1):1–5PubMedCrossRefGoogle Scholar
  13. 13.
    Katzenstein AL, Sale SR, Greenberger PA (1983) Allergic Aspergillus sinusitis: a newly recognized form of sinusitis. J Allergy Clin Immunol 72(1):89–93PubMedCrossRefGoogle Scholar
  14. 14.
    Lackner A, Stammberger H, Buzina W, Freudenschuss K, Panzitt T, Schosteritsch S, Braun H (2005) Fungi: a normal content of human nasal mucus. Am J Rhinol 19(2):125–129PubMedGoogle Scholar
  15. 15.
    Lehrer RI (1969) Antifungal effects of peroxidase systems. J Bacteriol 99(2):361–365PubMedGoogle Scholar
  16. 16.
    Manning SC, Holman M (1998) Further evidence for allergic pathophysiology in allergic fungal sinusitis. Laryngoscope 108(10):1485–1496PubMedCrossRefGoogle Scholar
  17. 17.
    Millar JW, Johnston A, Lamb D (1981) Allergic Aspergillosis of the maxillary sinuses. Thorax 36:710Google Scholar
  18. 18.
    Pant H, Kette FE, Smith WB, Macardle PJ, Wormald PJ (2006) Eosinophilic mucus chronic rhinosinusitis: clinical subgroups or a homogeneous pathogenic entity? Laryngoscope 116(7):1241–1247PubMedCrossRefGoogle Scholar
  19. 19.
    Ponikau JU, Sherris DA, Kern EB, Homburger HA, Frigas E, Gaffey TA, Roberts GD (1999) The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 74(9):877–884PubMedCrossRefGoogle Scholar
  20. 20.
    Singh N, Bhalodiya NH (2005) Allergic fungal sinusitis (AFS)— earlier diagnosis and management. J Laryngol Otol 119(11):875–881PubMedGoogle Scholar
  21. 21.
    Stroud RH, Calhoun KH, Wright ST, Kennedy KL (2001) Prevalence of hypersensitivity to specific fungal allergens as determined by intradermal dilutional testing. Otolaryngol Head Neck Surg 125(5):491–494PubMedGoogle Scholar
  22. 22.
    Schwietz LA, Gourley DS (1992) Allergic fungal sinusitis. Allergy Proc 13(1):3–6PubMedCrossRefGoogle Scholar
  23. 23.
    Scheuller MC, Murr AH, Goldberg AN, Mhatre AN, Lalwani AK (2004) Quantitative analysis of fungal DNA in chronic rhinosinusitis. Laryngoscope 114(3):467–471PubMedCrossRefGoogle Scholar
  24. 24.
    Watanabe K, Misu T, Ohde S, Edamatsu H (2004) Characteristics of eosinophils migrating around fungal hyphae in nasal discharge. Ann Otol Rhinol Laryngol 113:200–204PubMedGoogle Scholar
  25. 25.
    Weschta M, Rimek D, Formanek M, Polzehl D, Podbielski A, Riechelmann H (2004) Topical antifungal treatment of chronic rhinosinusitis with nasal polyps: a randomized, double-blind clinical trial. J Allergy Clin Immunol 113(6):1122–1128PubMedCrossRefGoogle Scholar
  26. 26.
    Zadeh MH, Banthia V, Anand VK, Huang C (2002) Significance of eosinophilia in chronic rhinosinusitis. Am J Rhinol 16(6):313–317PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Yusuf Hidir
    • 1
  • Fuat Tosun
    • 1
  • Mehmet Ali Saracli
    • 2
  • Armagan Gunal
    • 3
  • Mustafa Gulec
    • 4
  • Sertac Yetiser
    • 1
  1. 1.Department of ORL and HNSGulhane Military Medical Academy, Gulhane Medical SchoolAnkaraTurkey
  2. 2.Department of Clinical MicrobiologyGulhane Military Medical AcademyAnkaraTurkey
  3. 3.Department of PathologyGulhane Military Medical AcademyAnkaraTurkey
  4. 4.Department of Allergic DiseasesGulhane Military Medical AcademyAnkaraTurkey

Personalised recommendations