Chronic Rhinosinusitis (CRS)

Chronic rhinosinusitis (CRS) affects 12.5% of the US population. Approximately 9% of the U.S. population has asthma - 9% of adult asthmatics have aspirin-exacerbated respiratory disease (AERD) (http://goo.gl/FIeE9).

Risk factors for CRS

The following associations are found between CRS prevalence and:

- air pollution
- active cigarette smoking
- secondhand smoke exposure
- perennial allergic rhinitis
- gastroesophageal reflux (GERD)

The majority of pediatric and adult patients with CRS are immune competent (editor note: this has been challenged recently by a study that showed that more than 70% of adult patients with chronic sinusitis may have a poor response to pneumococcal immunization).


Nose and nasal cavities. Image source: Wikipedia, public domain.

Classification of CRS

- CRS without nasal polyposis (CRSsNP)
- CRS with nasal polyposis (CRSwNP)
- allergic fungal rhinosinusitis (AFRS)

Treatment of CRS

The highest level of evidence for treatment for CRSsNP exists for saline lavage, intranasal steroids, and long-term macrolide antibiotics.

The highest level of evidence for treatment of CRSwNP exists for intranasal steroids, systemic glucocorticoids, and topical steroid irrigations.

Aspirin desensitization is beneficial for patients with aspirin-intolerant CRSwNP.

Sinus surgery followed by use of systemic steroids is recommended for AFRS.

Other modalities of treatment, such as antibiotics for patients with purulent infection and antifungal drugs for patients with AFRS, are potentially useful despite a lack of evidence from controlled trials.

References:

Chronic rhinosinusitis: Epidemiology and medical management. Hamilos DL. J Allergy Clin Immunol. 2011 Sep 2.