The Diagnosis and Treatment of Chronic Rhinosinusitis

Abstract

Background: Chronic rhinosinusitis (CRS) is a heterogeneous condition characterized by local chronic inflammation of the mucous membranes of the nose and paranasal sinuses. It affects approximately 5% of the population.

Methods: This review is based on relevant publications retrieved by a selective search of the literature, with particular attention to current national and international guidelines.

Results: CRS is defined by, and diagnosed on the basis of, a combination of symptoms and objective findings of nasal endoscopy and imaging studies. It markedly impairs quality of life and gives rise to both direct and indirect health care costs. In 20-45% of cases, CRS is associated with comorbid bronchial asthma and a significantly elevated risk of further diseases (e.g., COPD, OR 1.73; depression, HR 1.50; obstructive sleep apnea, OR 1.91; carcinoma, OR 1.14-5.30). CRS is primarily treated medically with topical steroids (standardized mean difference of nasal symptoms, -0.63 (95% confidence interval [-0.89; -0.37]; standardized mean difference of quality of life as measured by SNOT -22, -5.46 [-8.08; -2.84]), as well as with nasal lavage and, as an option, systemic steroids (and antibiotics where appropriate). If appropriate medical treatment fails to bring about adequate and sustained improvement, endoscopic sinus surgery is indicated. This improves the individual symptoms, the overall symptom score, and patients' quality of life. Severe refractory CRS with nasal polyposis can be treated with biological agents.

Conclusion: CRS calls for individually adapted medical and/or surgical treatment.

Diagram

New classification of chronic rhinosinusitis. CRS, chronic rhinosinusitis; CRSwNP, chronic rhinosinusitis with nasal polyps; EGPA, eosinophilic granulomatosis with polyangiitis; GPA, granulomatosis with polyangiitis

Chronic rhinosinusitis

a) CRSwNP with endoscopically visible polyps and mucus secretion. b) CRSsNP with endoscopically visible mucosal swelling and mucus secretion. c) CT of the paranasal sinuses with opacfication in all paranasal sinuses and obstruction of the ostiomeatal unit in a patient with CRSsNP. d) CT of the paranasal sinuses with extensive opacfication of all paranasal sinuses due to diffuse polyposis in a patient with CRSwNP (1 = nasal polyps, 2 = middle turbinate, 3 = inferior turbinate, 4 = nasal septum, 5 = ostiomeatal complex). CRS, chronic rhinosinusitis; CRSsNP, chronic rhinosinusitis without nasal polyps; CRSwNP, chronic rhinosinusitis with nasal polyps