Résumé
Beaucoup de controverses existent toujours quant au rôle tenu par les virus, bactéries et champignons dans les affections rhino-sinusiennes. Une rhinite virale ne semble pas pouvoir à elle seule induire une sinusite aiguë clinique. Les bactéries déterminent l'image clinique et le devenir de la sinusite. Il n'y a pas trop de controverses quant au rôle des bactéries dans la sinusite aiguë, S. pneumoniae, H. influenzae and M. catarrhalis étant les bactéries les plus souvent retrouvées. Beaucoup plus de rapports contradictoires sont publiés concernant la flore normale des cavités sinusiennes, le rôle des anaérobies et la microbiologie de la sinusite chronique. Les liens entre pathologies infectieuses et allergiques sont plus compliqués à démontrer. Il semble que les virus, en particulier, peuvent influencer la libération de médiateurs inflammatoires et modifier l'évolution de la réaction inflammatoire. De même, leur rôle dans la destruction épithéliale, la mise à nu des terminaisons nerveuses, la sensibilisation de certaines cellules inflammatoires et par-delà, dans l'hyperréactivité des voies respiratoires en général, a été évoqué. Enfin dans le cadre des sinusites, diverses hypothèses ont été émises afin d'expliquer les liens possibles avec l'hyperréactivité bronchique.
Abstract
Much controversy still exists about the role of viruses, bacteria and fungi in nasal sinus diseases. Viral rhinitis alone does not seem to be able to elicit clinical acute sinusitis. Bacteria determine the clinical picture and outcome of sinusitis. S. pneumoniae, H. influenzae and M. catarrhalis are the bacteria most frequently involved. Much more conflicting reports are published about normal sinus flora, the role of anaerobes and the microbiology of chronic sinusitis. The relationship between infectious and allergic diseases ise more difficult to explain. It is shown that, in particular viruses can induce the release of inflammatory mediators and modify the inflammatory process. Their role in epithelial damage, excitation of nerve fibers, sensitization of inflammatory cells, and therefore, in general hyperreactivity has also been reported. Finally, with regard to sinusitis, different hypothesis have been proposed to explain the possible links with bronchial hyperreactivity.
Mots-Clés: Rhinite, Sinusite, Microbiologie, Allergie, Hyperréactivité bronchique
Key-Words: Rhinitis, Sinusitis, Microbiology, Allergy, Bronchial hyperreactivity
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