Chronic rhinosinusitis patterns of illness.

Chronic rhinosinusitis is a complex, multifactorial illness that has genetic, infectious, immune, anatomic, allergic, and inflammatory components. The syndrome is defined based on imprecise symptoms that lack specificity for the condition. Nonetheless, certain relatively characteristic patterns of illness can be identified within the syndrome, and these provide some insight into the underlying cause(s) of CRS. Furthermore, they form a basis for the clinical assessment and management of patients. In general, CRS without NP is a more heterogeneous subgroup of patients more likely to have facial pain, headache, chronic recurrent infection, defects in systemic or local immune function, and more likely to experience local infectious complications, such as facial osteomyelitis. In contrast, CRS with NP patients are more likely to have male gender, anosmia/hyposmia, a history of prior sinus surgery, asthma and aspirin sensitivity, allergy to house dust mite, and AFRS. In the next 17 chapters, an in-depth discussion of factors contributing to the pathophysiology of CRS will be presented that will provide further insight into the clinical patterns of illness described herein. Armed with this information plus the clinical framework outlined in this chapter, a stepwise medical evaluation and treatment strategy will be presented in Chapter 19.