Adjunctive surgical therapies in the treatment of rhinosinusitis

Abstract

Rhinosinusitis refers to any inflammatory condition of the nose and paranasal sinuses. Although the terms rhinitis and sinusitis are often used independently, the term rhinosinusitis reflects an understanding that most pathological processes will affect the entire mucous membrane of the nose and sinuses. Rhinosinusitis represents a heterogeneous group of diseases and is the end result of a myriad of pathophysiological processes that include infection, allergy, autoimmunity, environmental exposure, structural abnormalities, hormonal effects, and genetic disease. The interaction of multiple processes in each individual patient further complicates the understanding and management of the disease. Rhinosinusitis is very common. Approximately 32 million adults in the United States received a diagnosis of rhinosinusitis in 1998, reflecting 16% of the adult population [1]. Approximately 40 million Americans are estimated to be affected by allergic rhinitis each year, with half of these experiencing symptoms during 4 or more months of the year [2]. The direct health care costs associated with the management of sinusitis in the United States exceed $6 billion annually [1]. The indirect cost of rhinosinusitis, including missed days of work or school and decreased productivity while at work, may far exceed even this number. Further, these figures do not account for the costs of treating possible complications of rhinosinusitis such as asthma, otitis media, and sleep-disordered breathing. Rhinosinusitis also has a profound impact on quality of life that has long been overlooked. For example, in 2006 a large-scale survey of patients with allergic rhinitis found that 40% thought the disease impacted their life a "moderate amount" or "a lot" [3]. While nasal congestion, postnasal drip, rhinorrhea, and headache were labeled "extremely bothersome" by the largest number of subjects, the psychosocial morbidity of the disease appeared to be great as well. Forty-four percent of patients claimed they were frequently tired during allergy season, while 29% and 13%, respectively, frequently felt miserable and depressed. © 2008 Springer Science+Business Media, LLC. All rights reserved.