Nonpolypoid Rhinosinusitis: Pathogenesis, Diagnosis, Staging, and Treatment

Nonpolypoid Rhinosinusitis: Pathogenesis, Diagnosis, Staging, and Treatment

Zara M. Patel

Peter H. Hwang

Rhinosinusitis is one of the most common diseases diagnosed in the United States. Approximately 20 million cases of acute bacterial rhinosinusitis (ABRS) are diagnosed annually (1). In addition, more than 30 million people suffer from chronic rhinosinusitis (CRS). This corresponds to an annual prevalence of 13% to 16%, which has been increasing (2). CRS, therefore, is one the most common chronic conditions reported in the United States, more prevalent than asthma, heart disease, diabetes, or headache.

The costs associated with rhinosinusitis are substantial and are also increasing. Direct health care expenditures associated with acute rhinosinusitis are estimated at $3.5 billion annually, while those of CRS total $4.3 billion (1,3). These figures do not take into account indirect costs such as lost or restricted workdays or decreased productivity. For the individual CRS patient, this represents an approximate annual cost of $1,539 (4).

CRS can significantly worsen patients’ quality of life. When compared to the general population, CRS patients report more pain, less vitality, and decreased social functioning. Outcomes studies have shown that patients with CRS have worse scores in several quality of life domains compared to patients with chronic obstructive pulmonary disease, diabetes, and congestive heart failure (5).

Our understanding of the pathophysiology of CRS has improved dramatically over the last decade, although these findings have inevitably led to even more questions about CRS etiologies. Progress in basic science coupled with technologic improvements in endoscopy, imaging, and surgical technique have progressively enhanced our ability to diagnose and treat rhinosinusitis.