Chronic rhinosinusitis

Abstract:

Chronic rhinosinusitis (CRS) is an inflammatory disorder of the nasal mucosa and paranasal cavities defined by the presence of a combination of at least 2 CRS symptoms, one of which must be nasal congestion or nasal/postnasal secretion, while the other two symptoms are pain/pressure in the face or loss/reduction of sense of smell. Objective signs of inflammation must also be present on nasal endoscopy (at least 1 sign) and/or CT of the paranasal sinuses. CRS appears in 2 clinical phenotypes: with and without nasal polyps. These two phenotypes also differ according to the leading symptoms, CT severity scores, the polarization of the sinonasal mucosal immune response and response to steroid treatment. In patients with nasal polyps, obstruction and dysosmia are dominant symptoms, CT scores are higher and type 2 inflammation in the nasal mucosa and polyp tissue is present in 70 – 80% of patients. In CRS patients without nasal polyps, postnasal drip and facial pain predominate, CT scores are better, and type 1 inflammation dominates. Steroids are more effective in the phenotype with nasal polyps.

Key words:
chronic rhinosinusitis; comorbidity; computerized tomography (CD); diagnosis; endoscopy; predisposing factors