Chronic Rhinosinusitis
The diagnosis of chronic rhinosinusitis (CRS) is based on the patient's history, nasal endoscopy, and CT of the sinuses. Only recently has the pathophysiology (theory of causation) been understood.
During a typical day, an individual inhales 5-6 million fungi. While this does not affect a normal (non-affected) individual, it causes a cascade of events in certain patients. This is not an allergic reaction but an immunologic response to chemicals secreted by the fungus. The nasal and sinus mucous membranes become disrupted by chemicals released by eosinophils, a type of white blood cell, which leave blood vessels and enter the mucous membrane. Thick mucous is thereby secreted which is also rich in eosinophils. The process causes secondary bacterial infections, nasal polyps and post nasal drip.
CRS is one of the most common chronic diseases affecting an estimated 31 million patients in the U.S. The inflammation results in nasal congestion, mouth breathing, nasal discharge, and post nasal drip. Many patients need sinus surgery to reduce nasal obstruction and improve sinus drainage. Long term postoperative medical therapy is required. This can include oral steroids and use of an antifungal intranasal wash for many months.
Research is currently being done to better understand the disease process and how to better treat CRS.
Copyright ENT and Allergy Associates, LLP
Physicians:
04/15/2010
