Feature Article

Chronic rhinosinusitis: meeting the challenges

jason A Roth
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Chronic rhinosinusitis is a common condition that typically has a complex multifactorial pathophysio­logy. It is important to consider other conditions that can masquerade as sinusitis when making the diagnosis. Initial diagnosis and treatment begins in general practice but may require specialist assistance. Symptoms such as clear fluid rhinorrhoea, neurological symptoms and sudden loss of the sense of smell dictate more urgent referral.

Key Points

  • Chronic rhinosinusitis is defined by two or more of nasal obstruction, mucopurulent discharge, decreased sense of smell or facial pain, along with CT or endoscopic evidence of sinus disease.
  • Consider differential diagnoses according to symptoms; they include allergic rhinitis, headache syndromes such as migraine, laryngopharyngeal reflux and globus pharyngeus.
  • Nasal obstruction, a postnasal drip, headaches or loss of smell as sole individual symptoms are rarely due to sinusitis.
  • Once the diagnosis is made, commence a trial of maximal medical management.
  • If the patient does not respond to maximal medical management then referral to an ear, nose and throat specialist is warranted for further investigation and medical and possibly surgical management.
  • Removal of the adenoids is often helpful in children with chronic rhinosinusitis. 

    Picture credit: © Audra Geras