Diagnosis of chronic rhinosinusitis

Abstract

Chronic mucosal inflammation of the nose and paranasal sinuses is common. The symptoms of chronic rhinosinusitis (CRS) are thought to affect 16%, or 30 million, Americans in population-based studies [1,2]. While these surveys are questionnaire based and may overdiagnose the condition, even physician-diagnosed incidences are reported as2%to4%[3,4],which still represents anenormousdiseaseburden.Nosolid data have been published on the duration of episodes, whether treated or from natural resolution. CRS affects an increasing proportion of the adult population until the sixth decade, then declines [3]. The quality-of-life impact of the disease, as measured by SF-36 scores, is comparable or worse to other chronic conditions such as chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and back pain [5]. Identifying CRS patients correctly, from other sinonasal conditions, and providing health care interventions can greatly reduce the burden of disease within this group. We discuss the following concepts for the diagnosis of CRS: • Defining CRS • Presenting symptoms and differential diagnoses • Other significant patient history • Primary and secondary investigations • Diagnostic schemes and clinical workup This chapter discusses the current concepts of CRS with or without nasal polyps and an evidence-based review of the diagnostic methods. © 2008 Springer Science+Business Media, LLC. All rights reserved.