Chronic Rhinosinusitis – Causes, Symptoms & Treatment
Chronic rhinosinusitis is a long-term inflammation of the nasal mucosa and paranasal sinuses lasting more than 12 weeks, significantly affecting quality of life and daily functioning.
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Chronic rhinosinusitis is a long-term inflammation of the nasal mucosa and paranasal sinuses lasting more than 12 weeks, significantly affecting quality of life and daily functioning.
What is Chronic Rhinosinusitis?
Chronic rhinosinusitis (CRS) is an inflammatory condition of the nasal lining and the adjacent paranasal sinuses that persists for more than 12 weeks. It is one of the most common chronic conditions of the upper respiratory tract, affecting an estimated 5 to 12 % of the European population. CRS can significantly reduce quality of life by interfering with breathing, sleep, and general well-being.
Causes and Risk Factors
The causes of chronic rhinosinusitis are multifactorial. Several factors can contribute to the onset and persistence of chronic inflammation:
- Allergies: Allergic rhinitis (hay fever) substantially increases the risk of developing CRS.
- Anatomical abnormalities: A deviated nasal septum or narrow nasal passages can impair mucus drainage.
- Infections: Recurrent bacterial, viral, or fungal infections can lead to chronification.
- Nasal polyps: Benign growths of the nasal lining are frequently associated with CRS.
- Immune deficiency: A weakened immune system promotes chronic inflammatory processes.
- Environmental factors: Cigarette smoke, air pollution, and chemical irritants also play a role.
- Asthma: There is a strong association between asthma and CRS, particularly the subtype with nasal polyps.
Types of Chronic Rhinosinusitis
Clinically, CRS is divided into two main subtypes:
- CRS without nasal polyps (CRSsNP): The more common form, in which no visible polyps are present. Often related to bacterial biofilms or anatomical obstructions.
- CRS with nasal polyps (CRScNP): Characterized by benign mucosal growths in the nose or sinuses. Frequently associated with allergies, asthma, or aspirin intolerance.
Symptoms
The hallmark symptoms of chronic rhinosinusitis include at least two of the following complaints persisting for more than 12 weeks:
- Blockage or congestion of the nose (nasal obstruction)
- Discolored or purulent nasal discharge (rhinorrhea)
- Facial pressure or pain
- Reduced or absent sense of smell (hyposmia or anosmia)
Additional symptoms may include headaches, disturbed sleep, cough, and a general feeling of illness.
Diagnosis
The diagnosis of chronic rhinosinusitis is established through a combination of clinical assessment and technical investigations:
- Medical history and physical examination: Assessment of symptoms and nasal inspection.
- Nasal endoscopy: Direct visualization of the nasal mucosa and middle meatus using a thin endoscope.
- Imaging: A computed tomography (CT) scan of the paranasal sinuses is the gold standard for assessing the extent of inflammation and anatomical changes.
- Allergy testing: Skin prick tests or specific IgE measurements to identify or rule out an allergic component.
Treatment
Conservative Therapy
Conservative management is the first-line approach and includes:
- Intranasal corticosteroids: Corticosteroid nasal sprays (e.g., mometasone, fluticasone) are the mainstay of treatment for reducing mucosal inflammation.
- Nasal irrigation: Regular rinsing of the nasal passages with isotonic or hypertonic saline solution supports mucosal clearance.
- Antibiotics: In confirmed bacterial infections, antibiotics may be used over a longer course (e.g., low-dose azithromycin for their anti-inflammatory effects).
- Anti-allergic therapy: Antihistamines or allergen immunotherapy for patients with an underlying allergic condition.
- Systemic corticosteroids: Short courses of oral corticosteroids for severe symptoms or significant polyposis.
Biologics for Severe Disease
For severe CRS with nasal polyps that does not respond to conventional therapy, biologic agents have become available in recent years. Dupilumab, a monoclonal antibody targeting the IL-4 and IL-13 signaling pathway, is approved in Europe for this indication and has demonstrated significant symptom improvement and polyp reduction in clinical trials.
Surgical Treatment
When conservative measures are insufficient, functional endoscopic sinus surgery (FESS) may be performed. This minimally invasive procedure widens the sinus openings and removes polyps to improve mucus drainage and ventilation. Ongoing medical therapy after surgery is typically required to prevent recurrence.
Prognosis and Disease Course
Chronic rhinosinusitis is a long-term condition with a tendency to relapse. While complete resolution is possible, a significant proportion of patients experience a recurrent or persistent disease course. Regular ENT follow-up and consistent treatment are essential for maintaining quality of life.
References
- Fokkens WJ et al. - European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020). Rhinology. 2020;58(Suppl S29):1-464.
- Bachert C et al. - Biologics for chronic rhinosinusitis with nasal polyps. Journal of Allergy and Clinical Immunology. 2020;145(3):725-739.
- Orlandi RR et al. - International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021. International Forum of Allergy and Rhinology. 2021;11(3):213-739.
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Related search terms: Chronic Rhinosinusitis + Chronic Rhinosinusitis (CRS)