Chronic Sinusitis and Nonallergic Rhinitis

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Abstract
Syndromes of chronic sinusitis (CS) and nonallergic rhinitis (NAR) are poorly defined. There is a paucity of epidemiologic studies and long-term treatment outcome remains based mainly on anecdotal evidence. Clinical diagnoses must be differentiated from those made solely on radiographic criteria. The role of allergic disease in CS is undetermined. Many factors such as vascular reactivity, cellular infiltration, modifications of nasal secretions, anatomic abnormalities, deficiency of mucociliary clearance, immunodeficiency, and nasal reflexes contribute to symptom pathogenesis. The question whether NAR is a disease or an exaggerated physiologic response is controversial and is addressed in this contribution. Ultimately, enhanced knowledge of the pathophysiology of CS and NAR may lead to novel therapeutic approaches. Patients readily attribute a variety of symptoms such as postnasal drainage, facial fullness or swelling, head pressure, and nasal congestion to the paranasal sinuses. Unfortunately, many practitioners do not adopt a critical attitude to diagnosing sinus pathology and differentiating it from exaggerated physiologic responses to environmental factors. In this paper I will try to highlight some of the difficulties in this area.