title: Antifungal therapy in the treatment of chronic rhinosinusitis: a meta-analysis.
abstract: BACKGROUND
  Chronic rhinosinusitis (CRS) is an inflammatory disorder of the nose and sinuses. Because fungi were postulated as a potential cause of CRS in the late 1990s, contrasting articles have advocated and refuted the use of antifungal agents in its management. Although  good research shows an interaction of the immune system with fungus in CRS, e.g., allergic fungal sinusitis (AFS), this does not imply that fungi are the cause of CRS or that antifungals will be effective in management. This study was designed to assess the potential advantage of either  topical or systemic antifungal therapy in the symptomatic treatment of CRS to aid physicians in making informed decisions about treating patients with CRS.
  
  
  METHODS
  A systematic review of the literature was performed with meta-analysis. All studies obtained from searches  were reviewed and trials meeting the eligibility criteria were selected. CRS was defined using either the European Position Paper on Rhinosinusitis and Nasal Polyps or American Academy of Otolaryngology-Head and Neck Surgery criteria. Authors were contacted and original data were used  for data analysis.
  
  
  RESULTS
  Five studies investigating topical antifungals and one investigating systemic antifungals met the inclusion criteria. All trials were double blinded and randomized. Pooled meta-analysis showed no statistically significant benefit of topical or  systemic antifungals over placebo. Symptoms scores statistically favored the placebo group for this outcome. Adverse event reporting was higher in the antifungal group.
  
  
  CONCLUSIONS
  Reported side-effects of antifungal therapies may outweigh any potential benefits of treatment  based on this meta-analysis and the authors therefore do not advocate the use antifungal treatment in the management of CRS.
authors.affiliation: St. Vincent's Clinical School, St. Vincent's Hospital, University of New South Wales, New South Wales, Sydney, Australia. richard@sydneyentclinic.com
authors.forename: Peta-Lee
authors.initials: PL
authors.lastname: Sacks
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
authors.forename: Janet
authors.initials: J
authors.lastname: Rimmer
authors.forename: Richard M
authors.initials: RM
authors.lastname: Gallagher
authors.forename: Raymond
authors.initials: R
authors.lastname: Sacks
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D019468:Disease Management; D006801:Humans; D008825:Miconazole / Q000627:therapeutic use*; D009181:Mycoses / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D008825:Miconazole