Rhinosinusitis

Abstract

Rhinosinusitis is an inflammation of the sinonasal mucosa of any aetiology. It is the most common disease of the paranasal sinuses. Due to its frequent occurrence, chronicity, and high treatment costs, the correct approach and effective treatment are essential. It is classified as acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS). Allergy, asthma, and other lower respiratory tract diseases, non-steroidal antiinflammatory drugs (NSAIDs), exacerbated airway disease (N-ERD), immune deficiencies, gastroesophageal reflux disease (GERD), nasal anatomical variations, bacteria and biofilms, viruses, fungal infections, ciliary impairment, smoking, pollution, and alcohol are predisposing factors. Rather than the etiological factors that cause CRS, the interest is now focused on the inflammation that develops as a result in the sinus tissue. Once the barrier is crossed, a self-limiting immune defensive response occurs, characterised by a cellular and cytokine repertoire targeting one of three classes of pathogens. Nasal endoscopic examination may reveal oedema, discharge, crusting, scarring, and polyps. Computed tomography (CT) is the gold standard in the radiological evaluation of rhinological diseases, especially CRS. Treatment is primarily medical therapy. Surgical treatment is recommended when appropriate maximum medical treatment is not beneficial.