Chronic rhinosinusitis: Epidemiology and medical management

Chronic rhinosinusitis (CRS) affects 12.5% of the US population. On epidemiologic grounds, some association has been found between CRS prevalence and air pollution, active cigarette smoking, secondhand smoke exposure, perennial allergic rhinitis, and gastroesophageal reflux. The majority of pediatri...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology 2011-10, Vol.128 (4), p.693-707
Main Author: Hamilos, Daniel L., MD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Air pollution
Allergies
Allergy and Immunology
Biological and medical sciences
Child
Child, Preschool
Chronic Disease
Environmental Exposure - adverse effects
epidemiology
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Humans
Immunopathology
Infant
medical management
Medical sciences
nasal polyposis
Nasal Polyps - classification
Nasal Polyps - epidemiology
Nasal Polyps - etiology
Nasal Polyps - therapy
Non tumoral diseases
Nose
Otorhinolaryngology. Stomatology
Postoperative period
Prevalence
Rhinitis, Allergic, Perennial - classification
Rhinitis, Allergic, Perennial - epidemiology
Rhinitis, Allergic, Perennial - etiology
Rhinitis, Allergic, Perennial - therapy
Rhinosinusitis
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
sinusitis
Sinusitis - classification
Sinusitis - epidemiology
Sinusitis - etiology
Sinusitis - therapy
Studies
treatment
United States - epidemiology
Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
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Summary:Chronic rhinosinusitis (CRS) affects 12.5% of the US population. On epidemiologic grounds, some association has been found between CRS prevalence and air pollution, active cigarette smoking, secondhand smoke exposure, perennial allergic rhinitis, and gastroesophageal reflux. The majority of pediatric and adult patients with CRS are immune competent. Data on genetic associations with CRS are still sparse. Current consensus definitions subclassify CRS into CRS without nasal polyposis (CRSsNP), CRS with nasal polyposis (CRSwNP), and allergic fungal rhinosinusitis (AFRS). Evaluation and medical management of CRS has been the subject of several recent consensus reports. The highest level of evidence for treatment for CRSsNP exists for saline lavage, intranasal steroids, and long-term macrolide antibiotics. The highest level of evidence for treatment of CRSwNP exists for intranasal steroids, systemic glucocorticoids, and topical steroid irrigations. Aspirin desensitization is beneficial for patients with aspirin-intolerant CRSwNP. Sinus surgery followed by use of systemic steroids is recommended for AFRS. Other modalities of treatment, such as antibiotics for patients with purulent infection and antifungal drugs for patients with AFRS, are potentially useful despite a lack of evidence from controlled treatment trials. The various modalities of medical treatment are reviewed in the context of recent consensus documents and the author’s personal experience.
ISSN:0091-6749
1097-6825
DOI:10.1016/j.jaci.2011.08.004