Chronic rhinosinusitis (CRS) is one of the most common long-term illnesses in the United States, affecting approximately 14 percent of the population. CRS is a challenging condition to treat, partly due to its multifaceted, poorly understood pathophysiology. Treatment goals include maintaining open drainage and decreasing inflammation while improving tissue integrity and limiting causative factors. This review covers the etiology, pathology, and diagnosis of CRS, as well as mainstream and alternative treatments. Discussion of alternative therapeutics includes nutrients and botanicals (ascorbic acid, bromelain, N-acetylcysteine, quercetin, undecylenic acid, and Urtica dioica and other herbal medicines) and procedures (nasal irrigation and nasosympatico treatments). The influences of diet and air quality on CRS are also discussed. (Altern Med Rev 2006;11(3):196-207)
Chronic rhinosinusitis (CRS) is one of the most common chronic illnesses in the United States, with an estimated prevalence of 14 percent in the population. CRS more commonly develops in allergic patients and asthmatics (up to 30% and 43%, respectively). (1) In 2003, the mean medical cost was $921 per patient, with a total economic cost of $1,539 per patient, which includes an average of 4.8 missed work days annually. (2) The main reason for this burden is the multifaceted pathophysiology of CRS and the subsequent lack of consistently effective treatment.
Chronic rhinosinusitis involves the physiological disruption of the mucus membranes from particulates, allergens, infection, and immune system dysregulation. The term rhinosinusitis refers to inflammation of the contiguous tissues of the upper respiratory tract, where insult to the nasal mucosa also affects adjacent sinus tissue. Sinus pain may distinguish sinusitis from rhinitis, although it is agreed that 12 weeks of sinus inflammation is required for a diagnosis of CRS. (3)
The four pairs of sinuses (maxillary, frontal, ethmoidal, and sphenoidal) are partially enclosed cavities open to the nasal passages through small holes (ostea or meatus) (Figure 1). The warm, moist sinus environment they create is speculated to aid olfaction, increase vocal resonance, reduce the bony weight of the skull, and protect intracranial structures from trauma. (4) The ciliated epithelium, in coordination with mucus production, continually remove waste from the sinuses. However, when the ostea are closed, drainage is impeded and pressure increases, causing pain. With reduced sinus drainage comes an increased risk of microbial overgrowth within the mucus layer and in sinus tissue.
[FIGURE 1 OMITTED]
Chronic sinusitis is a sequela of acute sinusitis, which in turn can be a complication of allergic rhinitis or a viral upper respiratory infection (Figure 2). (5) This evolution begs two pivotal questions. First, why does acute rhinosinusitis, which appears as part of the normal clinical course of the common cold, (6) not always transition into CRS? Second, why don't all allergic rhinitis sufferers experience chronic rhinosinusitis? Whether due to anatomical factors, physiological factors, immune system involvement, or infectious agents, the common thread in CRS is a disruption of the normal production of sinus fluid and its outflow from the sinus cavities.
[FIGURE 2 OMITTED]
Anatomical sinus abnormalities are common in the general...