Chronic Rhinosinusitis (CRS)

Chronic Rhinosinusitis or “CRS” is defined as sinus inflammation involving the nasal mucosa and paranasal sinuses with 2 or more symptoms persisting for 12 weeksor longer with incomplete resolution of symptoms.[i]

Refractory chronic rhinosinusitis (“RCRS”) is a term used to describe CRS that is unresponsive or refractory to medical and surgical therapy.[ii]

Fungal rhinosinusitis encompasses a wide variety of fungal infections that range from merely irritating to rapidly fatal.  Invasive fungal Rhinosinusitis (“IFS”) is classified as either acute or chronic, is difficult to treat and is a significant cause of morbidity and mortality in immunocompromised patients.


Figure 1: Outline of the complex cycle in the development of CRS.
 Factors that may contribute to the development of CRS include exposure to allergens and irritants, defects in mucociliary function, immunodeficiency and infections with bacteria, viruses and fungi.  The common endpoint is local inflammation and swelling of the sinonasal mucosa and impairment of normal sinus drainage.  The recognition that CRS represents a multifactorial inflammatory disorder, rather than simply a persistent bacterial infection, has led to the re-examination of the role of antimicrobials in CRS.

The medical management of CRS is now focused upon controlling the inflammation that predisposes patients to obstruction, thus minimizing the incidence of infections.  Despite this, all forms of CRS are associated with poor sinus drainage and secondary bacterial infections.  Most patients require antibiotics to clear infections at the outset of therapy and intermittently thereafter to treat acute exacerbations of CRS.  However, the role of these agents beyond these two indications remains an area of investigation.[i]

[i]  Rosenfeld Richard M et al; Clinical practice guideline: Adult sinusitis Otolaryngology-Head and Neck Surgery (2007) 137, S1-S31

[ii]  Desrosiers M., Refractory chronic rhinosinusitis: pathophysiology and management of chronic rhinosinusitis persisting after endoscopic sinus surgery. Cur Allergy Asthma Rep. 2004 May; 4(3):200-7

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