Rhinosinusitis, chronic

Sinusitis, or inflammation of the paranasal sinuses, is better described as rhinosinusitis that also involves inflammation of contiguous nasal mucosa, which occurs in virtually all cases of viral respiratory infections. Acute rhinosinusitis is characterized by symptoms that resolve completely in less than 4 weeks, whereas chronic rhinosinusitis typically persists as cough, rhi-norrhea, or nasal obstruction for more than 90 days. Acute bacterial rhinosinusitis (ABRS) refers to an acute bacterial infection of the sinuses that can occur independently or be superimposed on chronic sinusitis. The focus of this section will be on ABRS and appropriate treatment. 

Corrigan C, Mallett K, Ying S, et al. (2005) Expression of the cysteinyl leukotriene receptors cysLT(l) and cysLT(2) in aspirin-sensitive and aspirin-tolerant chronic rhinosinusitis. J Allergy Clin Immunol. 115, 316-322. 

Riccio AAM, Tosco MA, Cosentino C, et al. Cytokine pattern in allergic and non-allergic chronic rhinosinusitis in asthmatic children. Clin Exp Allergy 2002 32 422-426. 

Suh YJ, Yoon SH, Sampson AP, et al Specific immunoglobulin E for staphylococcal enterotoxins in nasal polyps from patients with aspirin-intolerant asthma. Clin Exp Allergy 2004 34 1270-1275. Perez-Novo CA, Watelet JB, Claeys C, van Cauwenberge P, Bachert C Prostaglandin, leukotriene, and lipoxin balance in chronic rhinosinusitis with and without nasal polyposis. J Allergy Clin Immunol 2005 115 1189-1196. 

Citardi MJ, Song W, Batra PS, Lanza DC, Hazen SL. Characterization of oxidative pathways in chronic rhinosinusitis and sinonasal polyposis. Am J Rhinol 2006 20 353-359. 

Drug resistance The anti-inflammatory and immunomodulatory effects of macrolides have been reviewed [68 ]. There is evidence for the first-line use of macrolides in diffuse panbronchiolitis. There is some evidence for its use in cystic fibrosis, non-cystic fibrosis bronchiectasis, and chronic rhinosinusitis. Long-term use of low-dose macrolides can encourage the development of resistance in Gram-positive bacteria. However, this does not appear to alter efficacy. 

III. Chronic Rhinosinusitis and Reactive Upper Airways Dysfunction Syndrome... 

Figure 2 Treatment algorithm for WTC cough when presentation suggests that the primary causes are upper airway-related diseases—chronic rhinosinusitis and/or gastroesophageal reflux disorder.

The term refers to a distinct clinical syndrome characterized by aggressive and continuous inflammatory disease of the airways with chronic eosinophilic rhinosinus-itis, asthma and often nasal polyposis [6-8]. Aspirin and other NSAIDs that inhibit COX-1 exacerbate the condition, precipitating violent asthmatics attacks. This is a hallmark of the syndrome. The prevalence of aspirin hypersensitivity in the general population ranges from 0.6 to 2.5%, but is much more frequent in adult asthmatic subjects where it reaches 10-15%, although it is often underdiagnosed. 

Poe RH, Harder RV, Israel RH, KaUay MC (1989) Chronic persistent cough. Experience in diagnosis and outcome using an anatomic diagnostic protocol. Chest 95 723-728 Pratter MR (2006) Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome) ACCP evidence-based clinical practice guidelines. Chest 129 63S-71S... 

The classic aspirin triad or NSAID sensitivity consists of asthma, rhinosinusitis, and nasal polyps. Symptoms may develop stepwise over a number of years. In some patients only two of the main symptoms may be present. It is one of two cross-reactive types of NSAID sensitivity. This state of intolerance, which occurs more often in women than men, is observed in patients with aspirin-induced asthma, but the recently suggested name, aspirin-exacerbated respiratory disease, is probably a more appropriate designation for the condition that is essentially not a hue drag hypersensitivity but an underlying chronic inflammatory respiratory disease occasionally exacerbated by aspirin or some other NSAID. Ingestion of aspirin or some NSAIDs by these patients provokes, within 3 h (usually 30 min to 2 h), an acute... 

In sensitive subjects, aspirin (and other NS AIDs) is associated with the so-called aspirin triad or aspirin-induced asthma (AIA also called aspirin-exacerbated respiratory disease). Classic AIA consists of chronic asthma and rhinosinus-itis together with nasal polyps. The incidence of AIA in adult asthmatics is about 3-5 %. 

---