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Generally speaking, ‘sinusitis’ is defined as an inflammation of the mucosa of the nasal cavity
and paranasal sinuses. In and of itself the term “sinusitis” does not specify disease etiology or
pathophysiology. It describes a disease state. Therefore it is better thought of as a syndrome or a
constellation of symptoms and signs. In terms of accuracy however, the term ‘rhinosinusitis’,
rather than ‘sinusitis’ is recommended, as sinusitis is often preceded by, and rarely occurs
without, concurrent rhinitis.

Rhinosinusitis (RS) is subdivided into several different categories based on clinical presentation.
These include: acute RS, subacute RS, chronic RS (with and without polyps), recurrent acute RS,
acute exacerbation of chronic RS, and fungal RS. Acute rhinosinusitis is defined as being sudden
onset, again typically preceded by viral illness and lasts up to 4 weeks in duration. Chronic
rhinosinusitis, which may be present with or without polyps, is diagnosed after symptoms and
or signs have been present for more 12 weeks in duration. Major sign and symptoms of
rhinosinusitis include facial pressure/pain, congestion/fullness, nasal obstruction/blockage, nasal
discharge/purulence/post nasal drainage, hyposmia/anosmia (decreased sense of smell),
purulence in nasal airway, and fever (in acute). Minor signs and symptoms include heaqdache,
fever, halitosis, fatigue, dental pain, cough, and ear pain/pressure.
Symptoms are usually less severe than acute, and fever is not considered a major diagnostic
factor. Health experts estimate 37 million Americans are affected by rhinosinusitis each year.
Nearly 32 million cases of chronic sinusitis are reported to the Centers for Disease Control and
Prevention annually. As such chronic rhinosinusitis (CRS) is one of the most common chronic
health conditions in the United States.

The underlying pathophysiologic mechanisms of rhinosinusitis are not completely understood. It
is typically thought to begin with edema of the nasal and sinus mucosa, leading to disruption of
mucociliary clearance and perhaps innate immunity (cationic antimicrobial peptides). This, in
turn can lead to inflammation, sinus obstruction, mucous stasis, ciliary dysfunction, and possible
chronic infection with bacteria or fungus. There can be multiple causes of this initial
inflammatory insult. These may include viral infection, bacteria, fungi, dental infection,
environmental irritants, inhalant allergy, food allergy, aspirin sensitivity, immunodeficiency,
cystic fibrosis, primary ciliary dyskinesia, osteitis, biofilm formation, and anatomic variation.
Initial treatment of chronic rhinosinusitis usually involves tailored appropriate medical therapy
that may include protracted antimicrobial therapy (up to 4 or more weeks), as well as multiple
medications aimed at reducing inflammation. These may include topical intranasal steroids or
systemic steroids, antihistamines, and leukotriene modifiers. Anti-fungal medications, both
topical and systemic, may also be useful in selected patients with fungal involvement. Patients
who experience head pain with their rhinosinusitis may self medicate with over-the-counter nonsteroidal
anti-inflammatory agents (NSAIDs). Patients who fail optimal medical treatment may
be candidates for functional endoscopic sinus surgery (FESS) to improve sinus ventilation and
drainage. Endoscopic sinus surgery has been found to be very effective in alleviating symptoms
who fail maximal medical therapy.