Mechanisms of the symptoms of rhinosinusitis.

The review discusses the physiological and pathophysiological mechanisms associated with the symptoms of acute and chronic rhinosinusitis. An understanding of symptom mechanisms is important for the clinical diagnosis of rhinosinusitis and is important in assessing the efficacy of surgical and medical treatments for rhinosinusitis. The review will discuss the four primary symptoms used to diagnose rhinosinusitis: nasal obstruction, nasal discharge, facial pain and loss of sense of smell; and the secondary symptoms, cough, sneezing, sore throat and voice changes, epiphora, fever, and psychological effects and fatigue. The review will highlight that our understanding of a key diagnostic symptoms facial pain is limited, and that the incidence of pain with rhinosinusitis is controversial. Sneezing is a common symptom of acute rhinosinusitis with allergy but is not normally described as symptom in chronic rhinosinusitis and this anomaly is in need of more research. The mechanism of unilateral nasal obstruction with rhinosinusitis is discussed.