Microbiology and Immunology of Rhinosinusitis

  • Jean Anderson Eloy
  • Satish Govindaraj

Rhinosinusitis is one of the most common health care problems facing the primary care physician and results in significant heath care costs. With an increasing prevalence and incidence, it is believed that approximately 31 million Americans are affected by this condition annually [1, 2, 3, 4, 5]. Rhinosinusitis significantly impacts patients’ quality of life and results in marked physical, functional, and emotional impairment. Thus, a good understanding of the pathogenesis, microbiology, and immunology of this illness is needed for accurate diagnosis and proper treatment.

Rhinosinusitis represents a group of disorders characterized by inflammation of the nasal and paranasal sinus mucosa [6]. As such, it is presently thought that rhinosinusitis is initiated with an inflammatory insult (allergic rhinitis exacerbation, viral upper respiratory tract infection, rhinitis medicamentosa, etc.), followed by bacterial or fungal superinfection. Mucociliary clearance is the sinonasal cavity’s...


Paranasal Sinus Chronic Rhinosinusitis Mucociliary Clearance Secretory Leukocyte Proteinase Inhibitor Moraxella Catarrhalis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Agency for Health Care Policy and Research. Diagnosis and treatment of acute bacterial rhinosinusitis. Evid Rep Technol Assess (Summ) 1999; 9:1–5.Google Scholar
  2. 2.
    Benninger MS, Holzer SE, Lau J. Diagnosis and treatment of uncomplicated acute bacterial rhinosinusitis: Summary of the Agency for Health Care Policy and Research evidence-based report. Otolaryngol Head Neck Surg 2000; 122:1–7.Google Scholar
  3. 3.
    Gwaltney JM. Acute community acquired sinusitis. Clin Infect Dis 1996;23:1209–1223.PubMedCrossRefGoogle Scholar
  4. 4.
    Hyattsville, MD: National Ambulatory Medical Care Survey, 1990–1995. National Center for Health Statistics. Series 13 [CD-ROM].Google Scholar
  5. 5.
    Slavin RG. Management of sinusitis. J Am Geriatr Soc 1991; 39:212–217.PubMedGoogle Scholar
  6. 6.
    Benninger MS, Ferguson BJ, Hadley JA, et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 2003; 129(3 suppl): S1–S32.PubMedCrossRefGoogle Scholar
  7. 7.
    Winther B, Gwaltney JM Jr. Microbiology of sinusitis. In: Kennedy DW, Bolger WE, Zinreich SJ, eds. Diseases of the Sinuses: Diagnosis and Management. Hamilton, Ontario: Decker, 2001:77–84.Google Scholar
  8. 8.
    Winther B. The effect on the nasal mucosa of respiratory viruses (common cold). Dan Med Bull 1994; 41:193–204.PubMedGoogle Scholar
  9. 9.
    Winther B, Gwaltney JM Jr, Hendley JO. Respiratory virus infection of monolayer cultures of human epithelial cells. Am Rev Respir Dis 1990; 141:839–845.PubMedGoogle Scholar
  10. 10.
    Brook I. Microbiology and antimicrobial management of sinusitis. Otolaryngol Clin N Am 2004; 37:253–266.CrossRefGoogle Scholar
  11. 11.
    Gwaltney JM Jr, Sydnor A Jr, Sande MA. Etiology and antimicrobial treatment of acute sinusitis. Ann Otol Rhinol Laryngol Suppl 1981; 90:68–71.PubMedGoogle Scholar
  12. 12.
    Hamory BH, Sande MA, Sydnor A Jr, et al. Etiology and antimicrobial therapy of acute maxillary sinusitis. J Infect Dis 1979; 139:197–202.PubMedCrossRefGoogle Scholar
  13. 13.
    Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolarygol Head Neck Surg 1997; 117(3 pt 2): S1–S7.CrossRefGoogle Scholar
  14. 14.
    Hadley JA, Osguthorpe JD. Rhinosinusitis, 5th ed. Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 2006 [CD-ROM].Google Scholar
  15. 15.
    Brook I. Bacteriology of acute and chronic sphenoid sinusitis. Ann Otol Rhinol Laryngol 2002; 111:1002–1004.PubMedGoogle Scholar
  16. 16.
    Brook I, Frazier EH, Gher ME Jr. Microbiology of periapical abscesses and associated maxillary sinusitis. J Periodontol 1996; 67:608–610.PubMedCrossRefGoogle Scholar
  17. 17.
    Brook I, Friedman EM. Intracranial complications of sinusitis in children. A sequela of periapical abscess. Ann Otol Rhinol Laryngol 1982; 91:41–43.PubMedGoogle Scholar
  18. 18.
    Brook I, Frazier EH, Foote PA. Microbiology of the transition from acute to chronic maxillary sinusitis. J Med Microbiol 1996; 45:372–375.PubMedCrossRefGoogle Scholar
  19. 19.
    Chiu AG. Osteitis in chronic rhinosinusitis. Otolaryngol Clin N Am 2005; 38:1237–1242.CrossRefGoogle Scholar
  20. 20.
    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; 20:278–282.PubMedCrossRefGoogle Scholar
  21. 21.
    Palmer J. Bacterial biofilms in chronic rhinosinusitis. Ann Otol Rhinol Laryngol Suppl 2006; 196:35–39.PubMedGoogle Scholar
  22. 22.
    Harvey RJ, Lund VJ. Biofilms and chronic rhinosinusitis: systematic review of evidence, current concepts and directions for research. Rhinology 2007; 45:3–13.PubMedGoogle Scholar
  23. 23.
    de Shazo RD, O’ Brien M, Chapin K, et al. A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 1997; 123:1181–1188.CrossRefGoogle Scholar
  24. 24.
    Oliveria PJ, Zinreich SJ. Radiology of the nasal cavity and paranasal sinuses. In: Cummings CW, Fredrickson JM, eds. Otolaryngology-Head and Neck Surgery, vol 2, 3rd ed. St. Louis: Mosby-Year Book, 1998:1065–1091.Google Scholar
  25. 25.
    Notheis G, Tarani L, Costantino F, et al. Posaconazole for treatment of refractory fungal disease. Mycoses 2006; 49:37–41.PubMedCrossRefGoogle Scholar
  26. 26.
    Ferguson BJ. Definitions of fungal rhinosinusitis. Otolaryngol Clin N Am 2000; 33:227–235.CrossRefGoogle Scholar
  27. 27.
    Chakrabarti A, Sharma SC, Chandler J. Epidemiology and pathogenesis of paranasal sinus mycoses. Otolaryngol Head Neck Surg 1992; 107:745–750.PubMedGoogle Scholar
  28. 28.
    Henderson LT, Robbins KT, Weitzner S, et al. Benign mucor colonization (fungus ball) associated with chronic sinusitis. South Med J 1988; 81:846–850.PubMedCrossRefGoogle Scholar
  29. 29.
    Millar JW, Johnston A, Lamb D. Allergic aspergillosis of the maxillary sinuses. Thorax 1981; 36:710 (abstract).Google Scholar
  30. 30.
    Bent JP, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg 1994; 111:580–588.PubMedCrossRefGoogle Scholar
  31. 31.
    Manning SC, Schaefer SD, Close LG, et al. Culture-positive allergic fungal sinusitis. Arch Otolaryngol Head Neck Surg 1991; 117:174–178.PubMedCrossRefGoogle Scholar
  32. 32.
    Antunes MB, Cohen NA. Mucociliary clearance--a critical upper airway host defense mechanism and methods of assessment. Curr Opin Allergy Clin Immunol 2007; 7:5–10.PubMedCrossRefGoogle Scholar
  33. 33.
    Chen B, Shaari J, Claire SE, et al. Altered sinonasal ciliary dynamics in chronic rhinosinusitis. Am J Rhinol 2006; 20:325–329.PubMedCrossRefGoogle Scholar
  34. 34.
    Cohen NA. Sinonasal mucociliary clearance in health and disease. Ann Otol Rhinol Laryngol Suppl 2006; 196:20–26.PubMedGoogle Scholar
  35. 35.
    Lane AP, Truong-Tran QA, Schleimer RP. Altered expression of genes associated with innate immunity and inflammation in recalcitrant rhinosinusitis with polyps. Am J Rhinol 2006; 20:138–144.PubMedGoogle Scholar
  36. 36.
    Ramanathan M Jr, Lane AP. Innate immunity of the sinonasal cavity and its role in chronic rhinosinusitis. Otolaryngol Head Neck Surg 2007; 136:348–356.PubMedCrossRefGoogle Scholar
  37. 37.
    Schleimer RP, Lane AP, Kim J. Innate and acquired immunity and epithelial cell function in chronic rhinosinusitis. Clin Allergy Immunol 2007; 20:51–78.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Jean Anderson Eloy
  • Satish Govindaraj
    • 1
  1. 1.Department of Otolaryngology, Head and Neck SurgeryMount Sinai School of MedicineNew YorkUSA

Personalised recommendations