Biomechanical Effects of the Ethmoidal Isthmi on the Pathogenesis of Chronic Paranasal Sinusitis

Abstract

Only a few decades ago, the causes of chronic respiratory mucositis - either chronic otitis media or sinusitis - were ascribed to constitutional defects of the affected individuals (Aschoff, Wittmaack). Contemporary literature has confirmed that some occur due to the uncommon disorders mucoviscidosis or immotile cilia syndromes; however, this does not adequately explain why so many people develop chronicity or polyposis from acute sinusitis, but the majority does not. Since an experimental model of human chronic, progressive, polypoidal sinusitis has not yet been developed (except for a few investigations of maxillary sinusitis in rabbits), our knowledge of its pathogenesis is based on clinical observations. These investigations suggest that, while a variety of factors may influence the resolution (or non-resolution) of acute sinusitis, biomechanical factors are among the most prominent. This hypothesis is strongly supported by the observations that: (1) paranasal surgery with mechanical remodeling of the related anatomy often stops the disease and restores physiological function to an abnormal mucosa and (2) nasal trauma, which also mechanically changes the anatomy, frequently induces chronic sinusitis.