Skip to main content
SpringerLink
Log in

Osteitis in Chronic Rhinosinusitis

  • Rhinosinusitis (J Mullol, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Osteitis is recognized as a common factor in recalcitrant chronic rhinosinusitis (CRS). There is evidence for the association of osteitis with revision surgeries and CRS severity, in terms of higher Lund-Mackay scores. This is a narrative review on the osteitis in CRS patients.

Recent Findings

Evidence to date is inconclusive with regard to the etiology and pathogenesis of this bony thickening. Histopathology of osteitis in primary CRS is likely a process of neo-osteogenesis and bone remodeling. For better understanding, various associating factors have been studied including an inflammatory pattern of rhinosinusitis. Recent studies have associated osteitis with nasal polyps and tissue eosinophilia with the increase in periostin expression and P-glycoprotein mucosal expression. There is no association of osteitis to symptoms or quality of life. Osteitis is an outcome of neo-osteogenesis rather than inflammatory processes in CRS patients without a prior history of surgery. While CT has become a staple in osteitis assessment, the standards for grading osteitic severity remain in an experimental stage. There is no association between the presence or severity of osteitis at the time of surgery and clinical outcomes at 1 year after surgery.

Summary

This review provides a comprehensive overview of the pathogenesis, epidemiology, and correlation with clinical and biological factors of osteitis in CRS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Erlebacher A, Filvaroff EH, Gitelman SE, Derynck R. Toward a molecular understanding of skeletal development. Cell. 1995;80(3):371–8.

    Article  CAS  Google Scholar 

  2. Snidvongs K, McLachlan R, Chin D, Pratt E, Sacks R, Earls P, et al. Osteitic bone: a surrogate marker of eosinophilia in chronic rhinosinusitis. Rhinology. 2012;50(3):299–305.

    Article  CAS  Google Scholar 

  3. Lee JT, Kennedy DW, Palmer JN, Feldman M, Chiu AG. The incidence of concurrent osteitis in patients with chronic rhinosinusitis: a clinicopathological study. Am J Rhinol. 2006;20(3):278–82.

    Article  Google Scholar 

  4. Videler WJ, van Drunen CM, van der Meulen FW, Fokkens WJ. Radical surgery: effect on quality of life and pain in chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2007;136(2):261–7.

    Article  Google Scholar 

  5. Park CS, Park YS, Park YJ, Cho JH, Kang JM, Kim SY. The inhibitory effects of macrolide antibiotics on bone remodeling in chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2007;137(2):274–9.

    Article  Google Scholar 

  6. Schaberg MR, Anand VK, Singh A. Hyperostotic chronic sinusitis as an indication for outpatient intravenous antibiotics. Laryngoscope. 2010;120(Suppl 4):S245.

    Article  Google Scholar 

  7. Tovi F, Benharroch D, Gatot A, Hertzanu Y. Osteoblastic osteitis of the maxillary sinus. Laryngoscope. 1992;102(4):426–30.

    Article  CAS  Google Scholar 

  8. Kacker A, Huang C, Anand V. Incidence of chronic hyperostotic rhinosinusitis in patients undergoing primary sinus surgery compared to revision surgery. Rhinology. 2002;40(2):80–2.

    PubMed  Google Scholar 

  9. • Snidvongs K, Earls P, Dalgorf D, Sacks R, Pratt E, Harvey RJ. Osteitis is a misnomer: a histopathology study in primary chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4(5):390–6 A human study which investigated the inflammatory characterization of osteitis in primary chronic rhinosinusitis.

    Article  Google Scholar 

  10. Campos CA, Dolci EL, Silva L, Dolci JE, Campos CA, Dolci RL. Osteitis and mucosal inflammation in a rabbit model of sinusitis. Braz J Otorhinolaryngol. 2015;81(3):312–20.

    Article  Google Scholar 

  11. Antunes MB, Feldman MD, Cohen NA, Chiu AG. Dose-dependent effects of topical tobramycin in an animal model of Pseudomonas sinusitis. Am J Rhinol. 2007;21(4):423–7.

    Article  Google Scholar 

  12. Khalid AN, Hunt J, Perloff JR, Kennedy DW. The role of bone in chronic rhinosinusitis. Laryngoscope. 2002;112(11):1951–7.

    Article  Google Scholar 

  13. Perloff JR, Gannon FH, Bolger WE, Montone KT, Orlandi R, Kennedy DW. Bone involvement in sinusitis: an apparent pathway for the spread of disease. Laryngoscope. 2000;110(12):2095–9.

    Article  CAS  Google Scholar 

  14. Bolger WE, Leonard D, Dick EJ Jr, Stierna P. Gram negative sinusitis: a bacteriologic and histologic study in rabbits. Am J Rhinol. 1997;11(1):15–25.

    Article  CAS  Google Scholar 

  15. Norlander T, Westrin KM, Stierna P. The inflammatory response of the sinus and nasal mucosa during sinusitis: implications for research and therapy. Acta Otolaryngol Suppl. 1994;515:38–44.

    Article  CAS  Google Scholar 

  16. Westrin KM, Norlander T, Stierna P, Carlsoo B, Nord CE. Experimental maxillary sinusitis induced by Bacteroides fragilis. A bacteriological and histological study in rabbits. Acta Otolaryngol. 1992;112(1):107–14.

    Article  CAS  Google Scholar 

  17. Stevens PR, Tessema B, Brown SM, Parham K, Gronowicz G. Chronic rhinosinusitis osteoblasts differ in cellular properties from normal bone. Int Forum Allergy Rhinol. 2015;5(2):124–31.

    Article  Google Scholar 

  18. Cho SH, Min HJ, Han HX, Paik SS, Kim KR. CT analysis and histopathology of bone remodeling in patients with chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2006;135(3):404–8.

    Article  Google Scholar 

  19. Giacchi RJ, Lebowitz RA, Yee HT, Light JP, Jacobs JB. Histopathologic evaluation of the ethmoid bone in chronic sinusitis. Am J Rhinol. 2001;15(3):193–7.

    Article  CAS  Google Scholar 

  20. Kennedy DW, Senior BA, Gannon FH, Montone KT, Hwang P, Lanza DC. Histology and histomorphometry of ethmoid bone in chronic rhinosinusitis. Laryngoscope. 1998;108(4 Pt 1):502–7.

    Article  CAS  Google Scholar 

  21. Biedlingmaier JF, Whelan P, Zoarski G, Rothman M. Histopathology and CT analysis of partially resected middle turbinates. Laryngoscope. 1996;106(1 Pt 1):102–4.

    Article  CAS  Google Scholar 

  22. Emre IE, Celebi I, Ercan I. The radiologic evaluation of osteitis type and formation in chronic rhinosinusitis with and without nasal polyposis. Am J Rhinol Allergy. 2015;29(6):e201–4.

    Article  Google Scholar 

  23. Catalano PJ, Dolan R, Romanow J, Payne SC, Silverman M. Correlation of bone SPECT scintigraphy with histopathology of the ethmoid bulla: preliminary investigation. Ann Otol Rhinol Laryngol. 2007;116(9):647–52.

    Article  Google Scholar 

  24. Cho SH, Kim SY, Lee KY, Lee HC. New bone formation in unilateral rhinosinusitis. Am J Rhinol. 2007;21(1):37–9.

    Article  Google Scholar 

  25. Jang YJ, Koo TW, Chung SY, Park SG. Bone involvement in chronic rhinosinusitis assessed by 99mTc-MDP bone SPECT. Clin Otolaryngol Allied Sci. 2002;27(3):156–61.

    Article  CAS  Google Scholar 

  26. Nishimura T, Iizuka T. Diagnostic value of spect bone scintigraphy for odontogenic maxillary sinusitis. Clin Nucl Med. 2001;26(6):509–14.

    Article  CAS  Google Scholar 

  27. Javer AR, Stevens HE, Stillwell M, Jafar AM. Efficacy of nuclear scintigraphy in the diagnosis and management of sinusitis. J Otolaryngol. 1996;25(6):375–82.

    CAS  PubMed  Google Scholar 

  28. Kim HY, Dhong HJ, Lee HJ, Chung YJ, Yim YJ, Oh JW, et al. Hyperostosis may affect prognosis after primary endoscopic sinus surgery for chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2006;135(1):94–9.

    Article  Google Scholar 

  29. • Dong Y, Zhou B, Huang Z, Huang Q, Cui S, Li Y, et al. Evaluating bone remodeling by measuring Hounsfield units in a rabbit model of rhinosinusitis: is it superior to measuring bone thickness? Int Forum Allergy Rhinol. 2018;8(11):1342–8 An animal study which compared the diagnostic threshold values between the computed tomography value in Hounsfield units and bone thickness measurements.

    Article  Google Scholar 

  30. Dong Y, Zhou B, Wang X, Huang Z, Wang M, Li Y, et al. Computed tomography and histopathological evaluation of osteitis in rabbit models with rhinosinusitis. Acta Otolaryngol. 2017;137(5):534–40.

    Article  Google Scholar 

  31. Tian P, Zou H, Liu X, Chen QJ, Xie CC, Pan Z, et al. The radiologic evaluation of bony density change in chronic rhinosinusitis. Lin chuang er bi yan hou tou jing wai ke za zhi. 2016;30(22):1793–6.

    CAS  PubMed  Google Scholar 

  32. Bhandarkar ND, Sautter NB, Kennedy DW, Smith TL. Osteitis in chronic rhinosinusitis: a review of the literature. Int Forum Allergy Rhinol. 2013;3(5):355–63.

    Article  Google Scholar 

  33. Georgalas C, Videler W, Freling N, Fokkens W. Global Osteitis Scoring Scale and chronic rhinosinusitis: a marker of revision surgery. Clin Otolaryngol. 2010;35(6):455–61.

    Article  CAS  Google Scholar 

  34. Huang Z, Hajjij A, Li G, Nayak JV, Zhou B, Hwang PH. Clinical predictors of neo-osteogenesis in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2015;5(4):303–9.

    Article  Google Scholar 

  35. Snidvongs K, McLachlan R, Sacks R, Earls P, Harvey RJ. Correlation of the Kennedy Osteitis Score to clinico-histologic features of chronic rhinosinusitis. Int Forum Allergy Rhinol. 2013;3(5):369–75.

    Article  Google Scholar 

  36. Li YX, Lin F, Cheng L, Huang Q, Huang ZX, Zhang XQ, et al. Clinical application of modified global osteitis score in chronic rhinosinusitis. Lin chuang er bi yan hou tou jing wai ke za zhi. 2017;31(21):1666–70.

    CAS  PubMed  Google Scholar 

  37. Telmesani LM, Al-Shawarby M. Osteitis in chronic rhinosinusitis with nasal polyps: a comparative study between primary and recurrent cases. Eur Arch Otorhinolaryngol. 2010;267(5):721–4.

    Article  Google Scholar 

  38. Zuo K, Guo J, Chen F, Xu R, Xu G, Shi J, et al. Clinical characteristics and surrogate markers of eosinophilic chronic rhinosinusitis in southern China. Eur Arch Otorhinolaryngol. 2014;271(9):2461–8.

    Article  Google Scholar 

  39. Bhandarkar ND, Mace JC, Smith TL. The impact of osteitis on disease severity measures and quality of life outcomes in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2011;1(5):372–8.

    Article  Google Scholar 

  40. Mehta V, Campeau NG, Kita H, Hagan JB. Blood and sputum eosinophil levels in asthma and their relationship to sinus computed tomographic findings. Mayo Clin Proc. 2008;83(6):671–8.

    Article  Google Scholar 

  41. Dong D, Yulin Z, Xiao W, Hongyan Z, Jia L, Yan X, et al. Correlation between bacterial biofilms and osteitis in patients with chronic rhinosinusitis. Laryngoscope. 2014;124(5):1071–7.

    Article  Google Scholar 

  42. •• Gunel C, Feldman RE, Bleier BS. Osteitis is associated with P-glycoprotein overexpression in patients with chronic sinusitis without nasal polyps. Am J Rhinol Allergy. 2014;28(2):99–102 An experiment which assessed gene expression profiles between osteitic bone and the adjacent diseased mucosa in patients with chronic rhinosinusitis by microarray following RNA isolation.

    Article  Google Scholar 

  43. Ishida A, Ohta N, Suzuki Y, Kakehata S, Okubo K, Ikeda H, et al. Expression of pendrin and periostin in allergic rhinitis and chronic rhinosinusitis. Allergol Int. 2012;61(4):589–95.

    Article  CAS  Google Scholar 

  44. Wang M, Ye T, Liang N, Huang Z, Cui S, Li Y, et al. Differing roles for TGF-beta/Smad signaling in osteitis in chronic rhinosinusitis with and without nasal polyps. Am J Rhinol Allergy. 2015;29(5):e152–9.

    Article  Google Scholar 

  45. Gunel C, Bleier BS, Bozkurt G, Eliyatkin N. Microarray analysis of the genes associated with osteitis in chronic rhinosinusitis. Laryngoscope. 2017;127(3):E85–90.

    Article  Google Scholar 

  46. •• Wu D, Nocera AL, Mueller SK, Finn K, Libermann TA, Bleier BS. Osteitis is associated with dysregulated pro-osteoblastic activity in patients with nasal polyps. Laryngoscope. 2018;129(3):E102-E109. An experiment which assessed the bone morphogenetic protein pathway and its correlation with the degree of osteitis in patients with chronic rhinosinusitis with nasal polyps.

  47. Barham HP, Osborn JL, Snidvongs K, Mrad N, Sacks R, Harvey RJ. Remodeling changes of the upper airway with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2015;5(7):565–72.

    Article  Google Scholar 

  48. Kawaguchi H, Nemoto K, Raisz LG, Harrison JR, Voznesensky OS, Alander CB, et al. Interleukin-4 inhibits prostaglandin G/H synthase-2 and cytosolic phospholipase A2 induction in neonatal mouse parietal bone cultures. J Bone Miner Res. 1996;11(3):358–66.

    Article  CAS  Google Scholar 

  49. Onoe Y, Miyaura C, Kaminakayashiki T, Nagai Y, Noguchi K, Chen QR, et al. IL-13 and IL-4 inhibit bone resorption by suppressing cyclooxygenase-2-dependent prostaglandin synthesis in osteoblasts. J Immunol. 1996;156(2):758–64.

    CAS  PubMed  Google Scholar 

  50. Silfversward CJ, Larsson S, Ohlsson C, Frost A, Nilsson O. Reduced cortical bone mass in mice with inactivation of interleukin-4 and interleukin-13. J Orthop Res. 2007;25(6):725–31.

    Article  Google Scholar 

  51. Wang Y, Wu NN, Mou YQ, Chen L, Deng ZL. Inhibitory effects of recombinant IL-4 and recombinant IL-13 on UHMWPE-induced bone destruction in the murine air pouch model. J Surg Res. 2013;180(2):e73–81.

    Article  CAS  Google Scholar 

  52. Ebenezer JA, Christensen JM, Oliver BG, Oliver RA, Tjin G, Ho J, et al. Periostin as a marker of mucosal remodelling in chronic rhinosinusitis. Rhinology. 2017;55(3):234–41.

    Article  CAS  Google Scholar 

  53. Arjomandi H, Gilde J, Zhu S, Delaney S, Hochstim C, Mazhar K, et al. Relationship of eosinophils and plasma cells to biofilm in chronic rhinosinusitis. Am J Rhinol Allergy. 2013;27(4):e85–90.

    Article  Google Scholar 

  54. Cho SH, Shin KS, Lee YS, Jeong JH, Lee SH, Tae K, et al. Impact of chronic rhinosinusitis and endoscopic sinus surgery on bone remodeling of the paranasal sinuses. Am J Rhinol. 2008;22(5):537–41.

    Article  Google Scholar 

  55. Sacks PL, Snidvongs K, Rom D, Earls P, Sacks R, Harvey RJ. The impact of neo-osteogenesis on disease control in chronic rhinosinusitis after primary surgery. Int Forum Allergy Rhinol. 2013;3(10):823–7.

    Article  Google Scholar 

  56. Richtsmeier WJ. Top 10 reasons for endoscopic maxillary sinus surgery failure. Laryngoscope. 2001;111(11 Pt 1):1952–6.

    Article  CAS  Google Scholar 

  57. Chiu AG. Osteitis in chronic rhinosinusitis. Otolaryngol Clin N Am. 2005;38(6):1237–42.

    Article  Google Scholar 

  58. Georgalas C. Osteitis and paranasal sinus inflammation: what we know and what we do not. Curr Opin Otolaryngol Head Neck Surg. 2013;21(1):45–9.

    Article  Google Scholar 

  59. Beule AG, Scharf C, Biebler KE, Gopferich A, Steinmeier E, Wolf E, et al. Effects of topically applied dexamethasone on mucosal wound healing using a drug-releasing stent. Laryngoscope. 2008;118(11):2073–7.

    Article  CAS  Google Scholar 

  60. Beule A, Athanasiadis T, Athanasiadis E, Field J, Wormald PJ. Efficacy of different techniques of sinonasal irrigation after modified Lothrop procedure. Am J Rhinol Allergy. 2009;23(1):85–90.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Kornkiat Snidvongs

  2. Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Kornkiat Snidvongs

  3. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia

    Raymond Sacks & Richard J. Harvey

  4. University of Sydney, Sydney, Australia

    Raymond Sacks

  5. Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, Australia

    Richard J. Harvey

Authors
  1. Kornkiat Snidvongs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raymond Sacks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard J. Harvey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kornkiat Snidvongs.

Ethics declarations

Conflict of Interest

Kornkiat Snidvongs has served speakers’ bureau for the Merck Sharp Dolme and Menarini. Raymond Sacks is a consultant for the Medtronic and Olympus and speakers’ bureau for Seqiris Pharmaceutical. Richard J Harvey is a consultant with the Medtronic, Olympus, and NeilMed pharmaceuticals; he has been on the speakers’ bureau for the GlaxoSmithKlin, Seqiris, and Astra Zeneca.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Rhinosinusitis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Snidvongs, K., Sacks, R. & Harvey, R.J. Osteitis in Chronic Rhinosinusitis. Curr Allergy Asthma Rep 19, 24 (2019). https://doi.org/10.1007/s11882-019-0855-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11882-019-0855-5

Keywords

Search

Navigation