Definitions

Rhinosinusitis is one of the more prevalent chronic illnesses worldwide, affecting individuals of all ages. It is an inflammatory process that involves the nose and paranasal sinuses. Rhinosinusitis may be acute (ARS) or chronic (CRS). CRS can be subject to acute exacerbations. CRS can cause a significant degree of morbidity and it can reduce the individual’s quality of life and their productivity.

Rhinosinusitis is defined as (European Position Paper on Rhinosinusitis and Nasal Polyps – EPOS 2007):

• Inflammation of the nose and paranasal sinuses characterised by two or more of the following symptoms, one of which must be nasal blockage, obstruction, congestion or nasal discharge:

and either

• Endoscopic signs of:
  
  
  
  • polyps, and/or
    
  • mucopurulent discharge primarily from middle meatus, and/or
    
  • oedema and/or mucosal obstruction primarily in middle meatus

and/or

• Computed tomography (CT) changes:
  
  
  
  • mucosal changes within the osteomeatal complex or sinuses.

It is termed CRS if the symptoms last for more than 12 weeks without complete resolution.

Pathophysiology

CRS is predominantly a multifactorial inflammatory disease. There are four pairs of paranasal sinuses lined with ciliated, pseudo-stratified, columnar epithelium (Figure 20.1). Goblet cells are interspersed among the columnar cells. The mucosa is attached directly to the bone. The maxillary, frontal and anterior ethmoid sinuses drain through their ostia located at the osteomeatal complex lying lateral to the middle turbinate (middle meatus) and the posterior ethmoid and sphenoid sinuses open behind the superior turbinate (superior meatus; Figure 20.2).

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