An update on the classifications, diagnosis, and treatment of rhinosinusitis

This review is timely and relevant because rhinosinusitis is a disease process that is heterogeneous in its clinical and pathologic manifestations. Therefore, no one causative factor has been identified that fully accounts for all rhinosinusitis. The purpose of this review is to provide a succinct update of rhinosinusitis classification, pathophysiology, and management given the new movement toward evidence-based guidelines.

The term rhinosinusitis reflects the concurrent inflammatory and infectious processes that affect the nasal passages and the contiguous paranasal sinuses. The most recent classification scheme is intended primarily to guide clinical research and divides rhinosinusitis into four categories: acute bacterial rhinosinusitis, chronic sinusitis with nasal polyposis, chronic rhinosinusitis with nasal polyposis, and allergic fungal rhinosinusitis. The goals of treatment include reduction of mucosal edema, reestablishment of sinus ventilation, and eradication of infecting pathogens. Multiple therapies are available for the management of chronic rhinosinusitis, including antibiotics, hypertonic and isotonic saline irrigations or sprays, topical and systemic glucocorticords, antileukotriene agents, and endoscopic sinus surgery.

Rhinosinusitis is a common medical problem that interferes with patient quality of life and loss of work productivity. Because of the heterogeneity that underlies its pathology, no one treatment regimen exists for the management of rhinosinusitis.