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Rhinosinusitis: What is Chronic
Rhinosinusitis?
A diagnosis of chronic rhinosinusitis is made when
rhinosinusitis symptoms persist for more than 12 weeks despite medical
treatment and signs of inflammation are detected on a nasal examination. Chronic rhinosinusitis symptoms are similar to those of acute
rhinosinusitis (i.e., thick nasal or postnasal drainage, discomfort in the
cheeks, forehead or around the eyes, nasal congestion, cough and
headache) However, patients usually do not have a fever.
Chronic rhinosinusitis is one of the most common chronic
illnesses in Americans under 45 years of age. Approximately 20% of
patients with chronic rhinosinusitis develop nasal polyps. Nasal polyps are
growths that develop from sinus tissue. The resulting growth may cause
the sinus cavities to become blocked. Characteristic symptoms of chronic rhinosinusitis with polyps are same as those observed in chronic rhinosinusitis. Decreased sense of smell is often present. Surgery may be indicated if symptoms persist despite medical management. There were approximately 200,000
sinus surgeries performed in the United States in 1994. Chronic
rhinosinusitis with nasal polyposis is a common reason for sinus surgery.
Causes of chronic rhinosinusitis
Chronic sinus disease may be caused by blockage of the sinus
openings (called sinus "ostial obstruction"), problems with
the movement of mucus (called "mucociliary disturbances") or
a weakness in the immune system (called "hypogammaglobulinemia").
Factors such as allergies or bacterial infection also play a major
role in chronic sinusitis by producing inflammation in the sinus
membranes. This inflammation causes the sinus membranes to thicken,
which in turn further exacerbates the ostial obstruction and
infection. Once the process becomes chronic, it is often difficult to
determine which factors played the greatest role in the development of
chronic sinusitis.
Why do some cases of chronic
rhinosinusitis fail to resolve?
Both chronic infection and exposure to allergens can contribute to
sinus membrane inflammation that fails to clear up. People with
chronic rhinosinusitis should undergo an evaluation for allergies,
especially to test for allergens that are difficult to avoid, such as indoor
dust mites and molds. If you are found to be sensitive to
environmental allergens, you can reduce your exposure to them by
taking certain precautions. This may result in significant improvement
of your symptoms. For more information, see our Tips to Remember
brochures on Indoor Allergens
and Outdoor Allergens.
Rhinoscopy
Rhinoscopy (also known as nasal endoscopy) is a useful technique for
examining the nose and sinus passages. Rhinoscopy is done with a
flexible fiberoptic instrument that can be easily passed into the
nasal cavity. Rhinoscopy can provide valuable information, such as
whether the sinus passages are open. It is especially useful in
patients who have had previous sinus surgery. In such patients,
rhinoscopy can be very useful to assess the patient's progress after
sinus surgery and to see whether the sinus passages have remained open
or nasal polyps have regrown.
The rhinoscope is inserted through the nose to examine the nasal
passages and the sinus openings. A "side view" of the nasal
passages is shown below.
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