Rhinosinusitis describes a group of inflammatory conditions of the nasal mucosa and paranasal sinuses that affect 31 million people in the USA each year. When the term chronic rhinosinusitis (CRS) is used, it implies that the condition has persisted for more than 12 weeks despite medical therapy. The diagnosis of CRS requires the presence of at least two of the following over a 12-week period: anterior and posterior mucopurulent drainage; nasal obstruction; facial pain, pressure, and/or fullness; and a decreased sense of smell; nasal polyposis may or may not be present. Allergic rhinitis and asthma may be present concurrently in patients with CRS. Tobacco smoke and environmental irritants are known to exacerbate symptoms. Typically, CRS does not cause altered vision, proptosis, periorbital edema, ophthalmoplegia, focal neurologic signs, severe headache, fever, meningeal signs, or signs of systemic illness or vasculitis. The presence of these warning signs should prompt an immediate work-up for an alternative diagnosis. Treatment follows a multipronged approach including avoidance of allergens and irritants, saline lavage, chronic intranasal glucocorticoids, anti-inflammatory treatment with systemic glucocorticoids if symptoms are severe, and consideration of an initial empiric course of antibiotics.
KeywordsChronic rhinosinusitis Allergic rhinitis Acute rhinosinusitis Nasal polyposis Allergic fungal rhinosinusitis Aspirin-exacerbated respiratory disease Churg Strauss syndrome Wegener’s granulomatosis
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