Medically and historically, sinusitis has been divided into three categories:

• acute

• sub- acute

• chronic sinusitis

And this is mainly based on the disease duration. Chronic sinusitis symptoms last for more than 6 weeks and that is important to know.

 

Chronic rhino sinusitis is a common illness and it is estimated to affect more than 30 million Americans on a yearly basis, in fact it is getting to be similar in its prevalence to serious illnesses such as high blood pressure and diabetes which is not a pleasant thought and a distressing fact.

 

With regards to causes it is important to mention that most patients with chronic sinusitis do not have an infectious disorder and that is a little known fact that should be clarified and provided for patient education.

 

There are four major pathophysiologic processes that are responsible for the development of chronic sinusitis: The first is chronic or recurrent occlusion of the sinuses secondary to viral rhinitis second is allergic rhinitis, thirdly; anatomic predisposition such as structural abnormalities in the nasal passages themselves and fourth; other causes.

 

How Common Is Allergy In Patients Who Have Chronic Rhino – Sinusitis?

 

This is an excellent and extremely common question. Allergic rhinitis is an Immune-mediated disease in which the bodily exposure to an inhaled antigen elicits inflammatory changes in the nasal cells, resulting in a variety of nasal and non-nasal symptoms. The prevalence of allergic rhinitis in the population of the United States is estimated to range between 10% and 30% of the adult population.

 

It has also been estimated that up to 53% of people with allergic rhinitis have sinusitis, and up to 58% of individuals with sinusitis have allergic rhinitis- sound like trivia!

The sensitivity to multiple allergens and to perennial allergens, such as dust mites, pollen, and grass can certainly increase the risk for chronic sinusitis.

 

What Are The Main Mechanisms linking allergic rhinitis to chronic sinusitis?

 

Direct aeroallergen reaction

Aeroallergens, (The irritant) gains access to the nasal passages & lungs by being drawn into the respiratory tract while you breath in. Having said that, inspiration cannot drive these allergens into the sinus cavities directly but they do end up there through a more complicated diffusion process that is beyond this talk and thus the aggravation of the sinuses begins.

 

 

Infections

Acute bacterial infection sinusitis is not an uncommon complication of allergic rhinitis, usually secondary to occlusion of the sinuses and the stagnation of fluid within the sinus cavities. Many are unaware that the chronic sinusitis which complicates allergic rhinitis is rarely an infectious disease and chronic or recurrent occlusion of the sinuses may very well be responsible for the development of chronic inflammatory sinusitis.

 

 

Neurologic reflexes

A nasal–sinus neurologic reflex is supported by some data and a few studies but remains unlikely to explain what is predominantly an inflammatory disease process characterized by activated immune mediators and cellular response.

 

 

Systemic allergic mechanisms

The association between allergic rhinitis and sinusitis is related best to a systemic inflammatory process similar to that which develops between allergic rhinitis and asthma. Frequently, nasal allergen challenges in sensitive individuals produce radiographic changes of the sinuses that are evident on scans and X-rays and thus confirm the association. (Immunol Allergy Clin N Am24 (2004) 45– 57)

 

This article is a summary of the main mechanisms involved in chronic rhino sinusitis, a menace of a problem to have, which reflects a spectrum of inflammatory and infectious diseases of the nose and sinuses; this diversity has resulted in various definitions and classification systems that have unfortunately confused the patient and made research into its pathogenesis and treatment difficult.