Chronic sinusitis often coexists with chronic rhinitis and is called rhinosinusitis. Sinusitis is an inflammatory lesion involving the nasal cavity and one or more sinus mucosa. The mucosa of nose and paranasal sinuses is continuous, and the inflammation of paranasal mucosa is often caused by the inflammation of nasal mucosa. The causes may be mucosal ciliary system injury, (bacterial) infection, allergy and other causes of mucosal swelling, and only a few are caused by physical obstruction caused by morphological/anatomical variation of nasal cavity or sinus. The ostiomeatal complex of sinus is a functional structure consisting of maxillary sinus ostium, anterior ethmoid sinus and its opening, ethmoid funnel, semilunar fissure and middle nasal meatus, which plays a major role in the pathogenesis of sinusitis. The most basic element is to maintain the best nasal ventilation and cleanliness. The opening of sinus ostium can effectively affect the synthesis and secretion of mucus; In addition, it makes the mucociliary system easy to remove particles and bacteria.
If the sinus ostium is too small relative to mucus, mucus secretion increases (such as upper respiratory tract infection), or cilia function is damaged, problems will occur. When secretions stagnate and bacteria are excreted, it will cause or aggravate the inflammatory reaction of mucosa, and at the same time, the ventilation of mucosa will be reduced, resulting in ciliary dysfunction. These vicious cycles are difficult to stop, and if the situation continues, it will lead to chronic sinusitis.
physiopathology
Mucosal thickening, intimal edema, vascular wall thickening, lumen stenosis or even occlusion, and more round cells infiltration in the stroma. After acute suppurative sinusitis turns into chronic phase, some mucosa is destroyed, often accompanied by squamous metaplasia and granulation tissue formation, and the intima is obviously thickened, with a large number of lymphocytes and plasma cells infiltrating into it. Polyps may form locally. When sinusitis is serious, it can spread and invade adjacent tissues, causing corresponding histopathological changes, inducing osteomyelitis, orbital cellulitis, soft meningitis and brain abscess, and even leading to sepsis.
Among chronic sinusitis, nasal polyps are the most concerned, but previous studies have shown that there are many differences in pathogenesis, treatment and prognosis between chronic sinusitis without nasal polyps and chronic sinusitis with nasal polyps. For example, chronic sinusitis without nasal polyps mainly shows neutrophil infiltration, while most nasal polyps show a large number of eosinophil (EOS) infiltration. So some experts divide chronic sinusitis into nasal polyps and non-nasal polyps. There is little difference in subjective symptoms between the two groups, but objective examination shows that the mucosal lesions of patients with chronic sinusitis and nasal polyps are more serious and extensive, which is more significantly related to EOS infiltration in the mucosa.
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