Fungus has been cited as an etiologic factor (the etiologic factor?) in chronic rhinosinusitis (CRS), and a vigorous debate has ensued. Initial reports of in vitro observations promoted fungus as a potential origin of CRS, yet subsequent clinical trials of topical and systemic antifungal treatments have failed to demonstrate meaningful efficacy. More recent laboratory work has cast significant doubt on the universality of the fungal hypothesis by failing to replicate one of its basic science underpinnings. Combined with clinical data about antifungal therapy's ineffectiveness, these findings appear to tip the scales against fungus as the universal etiology of CRS.
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