Allergic and infective rhinosinusitis: differential diagnosis and interrelationship

Despite the growing emphasis on sinus surgery, the management of chronic or recurrent sinus problems remains multifaceted and should include consideration of contributory, correctable medical factors. Accurate differentiation between infective or allergic rhinosinusitis is often difficult if based only on history and physical examination. The character (and culture results) of mucus obtained from the sinus ostia region by endoscopy may confirm an infective problem, whereas positive results of specific allergy tests, supported by history, will confirm the presence of significant allergy. If complicating infection is not appropriately controlled, allergic management of rhinosinusitis will yield results that are less than optimum. Failure to recognize and treat contributory allergy may jeopardize the results of sinus surgery performed to resolve chronic infection.