title: Mucosal remodeling and reversibility in chronic rhinosinusitis.
abstract: OBJECTIVE
  Evidence suggests that some structural changes caused by mucosal remodeling may be primarily irreversible, which theoretically challenges the current management model of chronic rhinosinusitis (CRS). The relationship between inflammation and remodeling in the mucosa remains complex, yet better understanding of involved pathways holds potential clinical implications. This article reviews the controversies as well as current applications from the literature.
  
  
  RESULTS
  First, the relationship between inflammation and remodeling is a complex one involving multiple pathways, with evidence suggesting that remodeling is not a simple fibrotic end-stage process secondary to long-standing inflammation. Second, anti-inflammatory approaches alone are probably not successful in reversing changes such as collagen deposition, indicating that early treatment might be crucial for preventing disease progression. Third, a dysfunctional sinus remains a pure clinical/surgical phenomenon with lack of histological characterization. Fourth, maximal/extensive surgical techniques are advocated for patients with severe disease or dysfunctional sinuses.
  
  
  CONCLUSIONS
  Reversibility of remodeling holds implications for the management of CRS. Although clinical applications (both medical and surgical) exist, further research is required for solidifying current evidence as well as exploring new avenues for therapy.
authors.affiliation: Department of Surgery - Otorhinolaryngology, Head & Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bassiouni
authors.forename: Philip G
authors.initials: PG
authors.lastname: Chen
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
mesh_terms: D056151:Airway Remodeling; D002908:Chronic Disease; D003545:Cysteine / Q000502:physiology; D004802:Eosinophilia / Q000473:pathology; D006801:Humans; D015289:Leukotrienes / Q000502:physiology; D020780:Matrix Metalloproteinase 9 / Q000502:physiology; D012220:Rhinitis / Q000188:drug therapy / Q000473:pathology*; D012852:Sinusitis / Q000188:drug therapy / Q000473:pathology*
chemical_list: D015289:Leukotrienes; C112381:cysteinyl-leukotriene; D020780:Matrix Metalloproteinase 9; D003545:Cysteine