[Chronic rhinosinusitis of adults: new definition, new diagnosis]

Chronic rhinosinusitis of adults: new definition, new diagnosis. The three-nose theory, which is based on evolution and development of the nose, seems useful for a better understanding of chronic rhinosinusitis (CRS). The nose seems in fact to be composed of three noses (one olfactory, one respiratory and one sinusal nose), each of them being able to be affected by specific diseases. The concept of chronic nasal dysfunction (CND) is based on standardized recording of nose and sinus symptoms, irrespectively of their aetiology. Clinical, endoscopic and CT-scan check up is then aimed to look for a specific disease of one or the other of the three noses (nasal polyposis, chronic respiratory rhinitis, sinusitis…) or for a disease affecting simultaneously the three noses (rhinosinusitis), each disease leading if necessary to specific additional tests (allergic tests, tooth check-up, immune balance tests…). This implies specific therapeutic options, the effectiveness of the choosed one being evaluated by comparing the standardized recordings of nose and sinus symptoms.