Chronic sinusitis

Sinusitis is a very common chronic illness with a substantial health care i mpact. This review focuses on factors contributing to sinusitis pathogenesi s and chronicity, including anatomic factors, disturbances in mucociliary c learance, microbial pathogens, and inflammatory factors. A distinction is m ade between "infectious" and "noninfectious" types of inflammation in chron ic sinusitis, The inflammatory characteristics of noninfectious inflammatio n are reviewed primarily in the context of chronic hyperplastic sinusitis w ith nasal polyposis. Key features of this type of inflammation include the presence of chronic inflammatory cells, large numbers of eosinophils, and I L-5-producing T lymphocytes. Allergic fungal sinusitis is discussed as a sp ecial type of chronic sinusitis. Published studies on the outcomes of medic al management are reviewed. Finally, algorithms for medical management of c hronic sinusitis and allergic fungal sinusitis are presented.