Actual Concepts in Rhinosinusitis: A Review of Clinical Presentations, Inflammatory Pathways, Cytokine Profiles, Remodeling, and Management

Abstract

Rhinosinusitis (RS) is a heterogeneous group of diseases. It is a significant and increasing health problem that affects about 15% of the population in Western countries. It has a substantial impact on patients' health-related quality of life and daily functioning and represents a huge financial burden to society and the health care system as a result of the direct and indirect costs. In addition, RS is not well-understood, and little is known about the etiology and pathophysiology. In the past decade, many papers have been published that have changed our understanding of RS. RS is commonly classified into acute and chronic RS based on symptom duration. In acute RS, an inflammatory reaction initiated by a viral infection characterizes most uncomplicated, mild to moderate cases. Therefore, the first line of treatment for these cases are intranasal steroids and not antibiotics. In severe and complicated cases, antibiotics combined with topical steroids remain the treatment of choice. On the other hand, chronic RS is actually subdivided into two distinct entities (chronic rhinosinusitis with and without polyps), as growing evidence indicates that these entities have specific inflammatory pathways and cytokine profiles. The authors review recent data regarding the clinical presentations, cytokine profiles, tissue remodeling, and modalities of treatment for each form of RS.

Neutrophil: Lymphocyte Ratio and Mean Platelet Volume in Patients with Gout

“…It is reported that increased MPV is associated with Crohn's disease, rheumatoid arthritis, familial Mediterranean fever, ulcerative colitis, acute pancreatitis, ischemic stroke, diabetes mellitus, and myocardial infarction. In recent years, MPV has been considered a simple marker for inflammation in inflammatory disorders [12][13][14][15][16][17]. In a study on Behcet's disease, the MPV value was found to be significantly higher in the Behcet group compared to controls and it was reported to be associated with predisposition to thrombosis [18].However, in our study, no significant difference was found in MPV value in patients with gout.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Conditions that can contribute to ARS include rhinitis (allergic and nonallergic), coexisting medical conditions (CF, immune deficiency, ciliary dyskinesia), and environmental factors (smoking, daycare). 1388 Chronic conditions such as CF, immune deficiency, and ciliary dyskinesia are more likely to be associated with CRS.…”

Sinupret® oral drops protect against respiratory epithelium atrophy in experimental acute rhinitis

“…More than 90 % of URTI are caused by viruses, with a risk of developing subsequent bacterial infections in some patients [1]. The initial response of the nasal mucosa to the presence of a pathogen is an inflammatory reaction accompanied with mucus hypersecretion [1,2], resulting in increased mucus viscosity and eventually an impairment of mucociliary clearance. Mucus accumulation in the air passages promotes an extended contact of viruses or bacteria with the mucosal lining of the sinuses facilitating pathogen colonization.…”

“…Further sinuses and nasal congestion due to a mucosal edema provokes a drop in the tissue oxygen tension, and impairs the barrier functions of the mucosa. Impaired mucus clearance and a decrease in the partial pressure of oxygen are optimal conditions for bacterial development and infections, thus creating as a vicious circle of pathological processes [1,2]. In the case of chronic inflammation, a diffuse metaplasia turning functional columnar ciliated epithelium into stratified multilayer epithelium occurs whereby the mucociliary transport is impaired [2][3][4][5].…”

“…Impaired mucus clearance and a decrease in the partial pressure of oxygen are optimal conditions for bacterial development and infections, thus creating as a vicious circle of pathological processes [1,2]. In the case of chronic inflammation, a diffuse metaplasia turning functional columnar ciliated epithelium into stratified multilayer epithelium occurs whereby the mucociliary transport is impaired [2][3][4][5]. The herbal medicinal product Sinupret®, composed of Gentianae radix, Primulae flos cum calycibus, Sambuci flos, Rumicis herba and Verbenae herba, is frequently used for the treatment of acute or chronic rhinosinusitis [6,7] due to its pleiotropic effects directed against viral replication [8], bacterial infection, and inflammation [9].…”