Definition and symptoms of chronic rhinosinusitis
Rhinosinusitis refers to concurrent inflammation of the mucosal lining of the nose (rhinitis) and the paranasal sinuses (sinusitis). Rhinitis that occurs in isolation is usually caused by an allergy; see Allergic rhinitis.
Rhinosinusitis is classified as acute (symptoms lasting less than 4 weeks) or chronic (symptoms lasting longer than 12 weeks). Acute rhinosinusitis is most commonly caused by a viral infection—for information on acute viral rhinosinusitis (the common cold), see here.
Chronic rhinosinusitis is characterised by the presence of two or more of the following symptoms for more than 12 weeks:
- nasal blockage (obstruction or congestion)
- mucopurulent nasal discharge (anterior or posterior drip)
- facial pain or pressure
- reduction of loss of sense of smell.
Some patients can also experience cough or nausea. Patients with coexisting allergic rhinitis may also have symptoms such as sneezing, rhinorrhoea, nasal itching and itchy watery eyes.
Chronic rhinosinusitis is usually related to multiple contributing factors, which can include:
- bacterial infection
- allergy
- cystic fibrosis
- physical obstruction (including nasal polyps or anatomical variation)
- swelling of the mucosa
- mucociliary impairment
- immune deficiency
- prolonged use of intranasal decongestants (rhinitis medicamentosa).
Chronic rhinosinusitis is uncommon in children younger than 12 years. If chronic rhinosinusitis is suspected in a child, consider referral to a paediatrician or an ear, nose and throat surgeon.