Definition and classification
Chronic rhinosinusitis (CRS): sinonasal inflammation lasting at least 12 weeks, with at least two symptoms. One must be obstruction or anterior/posterior discharge; the others may include facial pressure or reduced smell. Confirm inflammation by endoscopy or CT.
CRSwNP and CRSsNP describe CRS with and without nasal polyps. A phenotype does not establish an endotype.
More detail
Type 2 inflammation involves eosinophils, mast cells and IL-4, IL-5 and IL-13. Some patients without polyps have type 2 disease; some polyp disease has other or mixed pathways.
Classify primary or secondary, then localised or diffuse disease. Identify a dental, fungal, neoplastic or systemic cause before escalating treatment for presumed primary inflammation.
Pattern | Examples and consequence |
|---|---|
Localised primary | Isolated sinus inflammation or allergic fungal disease; define the involved sinus and drainage pathway |
Diffuse primary | Type 2, non-type 2 or mixed inflammation; combine symptom assessment with endoscopy and associated airway disease |
Localised secondary | Odontogenic infection, fungal ball or tumour; treat the cause as well as sinus disease |
Diffuse secondary | CF, PCD, immunodeficiency or vasculitis; joint care with the relevant specialist |
Recurrent acute rhinosinusitis means at least four distinct episodes per year, with complete resolution between them. Persistent symptoms between exacerbations favour CRS.