DEFINITION

Sinuses rarely get infected without the nose being involved, so the term rhinosinusitis is
used instead of sinusitis (Thornton K 2011). CRS is a common disorder characterized
by mucosal inflammation of the nose and paranasal sinuses with sinonasal symptoms
persisting for greater than 12 weeks. (Cain RB 2013)

ETIOLOGY
Regarding the etiology of CRS, numerous hypotheses have been proposed with a great
deal of overlap, supporting a multifactorial basis. One classification method separates
potential contributing entities into host and environmental factors (Table 1). The
heterogeneous nature of CRS is important to understand when planning treatment for
this diverse group of patients whose disease may have arisen from very different
underlying etiologies. (Cain RB 2013)

Table 1. Factors associated with chronic rhinosinusitis (Benninger MS)
Systemic host factors Local host Environmental
Allergic
Immunodeficiency
Genetic/congenital
Mucociliary dysfunction
Endocrine
Neuromechanism
Anatomic
Neoplastic
Acquired mucociliary
dysfunction
Microorganisms (viral, bacterial, fungal)
Noxious chemicals, pollutants, smoke
Medications
Trauma
Surgery



DIAGNOSIS
Chronic rhinosinusitis, with or without nasal polyps in adults is
defined as:
inflammation of the nose and the paranasal sinuses
characterised by two or more symptoms, one of which
should be either nasal blockage/obstruction/congestion or
nasal discharge (anterior/posterior nasal drip):
} facial pain/pressure
} reduction or loss of smell
for 12 weeks
This should be supported by demonstrable disease
Either endoscopic signs of:
nasal polyps, and/or
mucopurulent discharge primarily from middle meatus
and/or
oedema/mucosal obstruction primarily in middle meatus
and/or
CT changes:
mucosal changes within the ostiomeatal complex and/or sinuses

Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F et al. European Position
Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinology 2012 (suppl 23):1-298
Cain RB, Lal D. Update on the management of chronic rhinosinusitis. Infection and
Drug Resistance 2013;6:114
Benninger MS, Ferguson BJ, Hadley JA. Adult chronic rhinosinusitis: definitions,
diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg.
2003;129(Suppl 3):S1S32.