Chronic sinusitis

Chronic rhinosinusitis defined by symptoms present for at least three months and can occur with or without acute exacerbation, and with or without nasal polyposis.

Defined by symptomatic inflammation of the paranasal sinuses with common symptoms including nasal obstruction, facial pressure or fullness, nasal discharge, and olfactory loss.

Associated with reductions in quality-of-life, sleep quality, and daily productivity.

Estimated prevalence is 12% in Western countries.

A common und2242ecognized chronic inflammatory disease affecting proximally 3-7% of the population.

Can be divided into chronic sinusitis with or without nasal polyposis.

Healthcare costs estimated $9 billion per year with societal cost exceeding $13 billion per year.

Previously thought to be entirely infectious in its etiology.

Now recognized as an inflammatory process of the upper airways analogous to asthma in the lower airways.

The etiology is multi factorial including bacterial agents, epithelial cell defects, bacterial biofilms, T-helper 1 and 2 inflammation , tissue remodeling, genetic variations in HLA haplotypes and bitter-taste receptors.

Bitter-taste receptors have genetic variation and can be associated with refractory chronic sinusitis.

Normally sinonasal-ciliated epithelium cells express bitter-taste receptors stimulated by bacterial products and activate immune host responses to remove and kill bacteria by releasing nitric oxide.

Presently chronic sinusitis is classified based on the presence or absence of nasal polyps.

Chronic rhinosinusitis without nasal polyps may be idiopathic or ontogenic or caused by immuno deficiency, vasculitis or autoimmune processes.

Smoking is not a strong risk factor for chronic rhinosinusitis with nasal polyps.

The majority of chronic rhinosinusitis sinusitis with nasal polyps are idiopathic or may be related to genetic, metabolic, or immunologic diseases.

The majority of Caucasians with chronic rhinosinusitis with nasal polyps have a type two pattern of inflammation, with eosinophilia, and elevated levels of interleukin-4, interleukin-5, and interleukin 13 cytokines.

The goals of medical treatment is to reduce mucosal inflammation, remove mucus, and modulate environmental triggers.

Most common bacterial organisms are Staphylocci epidermidis, Staphylococci aureus, Streptococcus pneumoniae and anaerobes.

Medical therapy begins with daily application of topical intranasal corticosteroids in conjunction with high-volume saline irrigation.

Medical management with chronic sinusitus and nasal polyposis focuses on controlling inflammation and includes intranasal corticosteroids, nasal saline irrigation, use of antibiotics, or oral steroids.

If symptoms and polyps persist, despite medical management, surgical excision is a consideration.

Reoccurrence of sinusitus symptoms and polyposis after surgery approaches 50% in patients with tissue eosinophilia.

Associated with his 3.5 fold increase in prevalence of asthma.

Topical corticosteroid therapy for chronic sinusitis with and without nasal polyps is highly recommended for chronic sinusitis.

High volume corticosteroid irrigations may be more effective than low-volume corticosteroid spray techniques but clinical trials are required.

Saline irrigationsassist in the removal of mucus and possible environmental triggers and assist in restoring normal mucociliary clearance.

While saline irrigations improve symptoms scores, it alone is associated with less improvement than when utilized with topical corticosteroid therapy.

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