title: Palliative care for the patient with refractory chronic rhinosinusitis.
abstract: Most otolaryngologists encounter patients with chronic rhinosinusitis who, despite conventional medical and surgical therapy, fail to show significant symptomatic improvement. Many paradigms have been proposed to explain the mechanisms responsible for refractory disease in these patients, including superantigen activation, biofilm formation, and eosinophil activation triggered by fungal elements. Although the precise underlying etiology of this clinical scenario remains unclear, the resultant pathophysiologic events share a final common pathway marked by inflammatory changes of the sinonasal mucosa. This article reviews the proposed hypotheses as to why some patients with chronic sinusitis fail conventional therapy and highlights treatment options useful in the palliative treatment of these patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, FGH Building, 820 Harrison Avenue, One Boston Medical Center Place, Boston, MA 02118, USA. Elizabeth.mahoney@bmc.org
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Mahoney
authors.forename: Ralph
authors.initials: R
authors.lastname: Metson
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002908:Chronic Disease; D006801:Humans; D010166:Palliative Care; D011788:Quality of Life; D012220:Rhinitis / Q000503:physiopathology / Q000628:therapy*; D012852:Sinusitis / Q000503:physiopathology / Q000628:therapy*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents