rhinosinusitis

Rhinosinusitis refers to inflammation of the nasal mucosa and one or more of the paranasal sinuses. Common symptoms include nasal congestion, facial pain or pressure, purulent nasal discharge, reduced sense of smell, and sometimes fever or cough. The condition is categorized by duration and pattern: acute rhinosinusitis (ARS) lasts less than 4 weeks; subacute 4–12 weeks; chronic rhinosinusitis (CRS) lasts 12 weeks or longer; recurrent acute rhinosinusitis (RARS) involves four or more episodes per year with full symptom resolution between episodes. CRS is further divided based on the presence or absence of nasal polyps: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Most ARS cases begin with a viral upper respiratory infection; bacterial infection is a minority contributor. CRS is linked to inflammatory and environmental factors, including allergic disease, impaired mucociliary clearance, and smoking.

Diagnosis is primarily clinical. Imaging and endoscopic examination are used selectively, especially for CRS or suspected complications. CT imaging helps define disease extent and plan surgery; nasal endoscopy can reveal polyps, drainage, and ostial blockage. Management focuses on symptom relief and reducing inflammation: saline nasal irrigation and intranasal corticosteroids are central, with short courses of systemic decongestants as needed. Antibiotics are reserved for ARS with a high likelihood of bacterial infection, typically when symptoms persist beyond about 10 days, are severe at onset, or worsen after an initial improvement. CRS often requires longer courses of intranasal steroids, potential antibiotics for infectious flares, and referral for functional endoscopic sinus surgery if medical therapy fails. Complications, though uncommon, can include orbital or intracranial involvement. CRS is a common condition affecting quality of life and is associated with factors such as allergic rhinitis, asthma, immune dysfunction, and smoking.