title: Other Phenotypes and Treatment of Chronic Rhinosinusitis.
abstract: Chronic rhinosinusitis (CRS) is difficult to define, partly because the disease recognized by clinicians is both heterogeneous and the endpoint of different pathophysiologic, genetic, and environmental interactions. For this article, we define CRS as symptoms lasting more than 3 months combined with an imaging study showing inflammation in the sinuses. This article comments on some factors that are believed to influence the expression of CRS. These factors include anatomic abnormalities, immotile cilia, age, allergic sensitization, immune deficiency, dental infections, gastrointestinal reflux, smoking, biofilm, and the microbiome. Other factors are discussed in other sections. The article concludes with an overview of treatment. In brief, nasal steroids and large volume nasal irrigations are the first line of treatment for this inflammatory disease. Antibiotics are used when infections are thought to contribute. Oral steroids are frequently used in severe disease. Endoscopy and sinus computed tomography scans are used when surgery is contemplated.
authors.affiliation: Department of Surgery, Section of Otolaryngology, Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, Ill. Electronic address: rnacleri@surgery.bsd.uchicago.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Naclerio
authors.affiliation: Department of Surgery, Section of Otolaryngology, Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, Ill; Department of Pediatrics, The University of Chicago Medicine and Biological Sciences, Chicago, Ill.
authors.forename: Fuad M
authors.initials: FM
authors.lastname: Baroody
mesh_terms: D000818:Animals; D001327:Autoimmune Diseases; D002908:Chronic Disease; D002923:Cilia / Q000502:physiology; D015897:Comorbidity; D005764:Gastroesophageal Reflux; D006801:Humans; D006967:Hypersensitivity; D007153:Immunologic Deficiency Syndromes; D064307:Microbiota; D010641:Phenotype; D012220:Rhinitis / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D012852:Sinusitis / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D012907:Smoking
keywords: Allergy; Anatomic; Biofilm; GERD; Immotile cilia; Microbiome; Smoking; Treatment