Rhinosinusitis pathophysiology: Difference between revisions
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Revision as of 18:03, 26 September 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
Pathophysiology
Pathogenesis
Acute Rhinosinusitis
The sinuses are air-filled spaces in the skull (behind the forehead, nasal bones, cheeks, and eyes) that are lined with mucus membranes. Healthy sinuses are well-aerated and contain no bacteria. Usually, mucus is able to drain out and air is able to circulate. When the sinus openings become blocked due to swelling of the nasal mucosa, it provides a medium for an inflammatory response to ensue. Inflammation is mediated by protease in granulocytes and if the amount of protease overwhelms the amount of protease inhibitors available, tissue destruction will take place.[1]
Chronic Rhinosinusitis
Biofilms are complex aggregates of extracellular matrix and inter-dependant microorganisms from multiple species, many of which may be difficult or impossible to isolate using standard clinical laboratory techniques. Bacteria found in biofilms may show increased antibiotic resistance when compared to free-living bacteria of the same species. It has been hypothesized that biofilm-type infections may account for many cases of antibiotic-refractory chronic sinusitis. While biofilms have been implicated in the pathogenesis of chronic sinusitis, more research needs to be done in order to understand their role in causing inflammation and disease. [2][3][4]
Genetics
Chronic rhinosinusitis is believed to be the result of environmental and genetic factors combined. The role of genetic factors in chronic rhinosinusitis is not yet fully understood.[5] However, in chronic rhinosinusitis with and without nasal polyposis, first and second degree relatives conferred an increased risk to receiving the same diagnosis.[6]
Associated Conditions
Gross Pathology
Microscopic Pathology
References
- ↑ Lundberg C, Engquist S (1983). "Pathogenesis of maxillary sinusitis". Scand J Infect Dis Suppl. 39: 53–5. PMID 6580734.
- ↑ Harvey RJ, Lund VJ (2007). "Biofilms and chronic rhinosinusitis: systematic review of evidence, current concepts and directions for research". Rhinology. 45 (1): 3–13. PMID 17432062.
- ↑ Palmer JN (2005). "Bacterial biofilms: do they play a role in chronic sinusitis?". Otolaryngol. Clin. North Am. 38 (6): 1193–201, viii. PMID 16326178.
- ↑ Sanclement J, Webster P, Thomas J, Ramadan H (2005). "Bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis". Laryngoscope. 115 (4): 578–82. PMID 15805862.
- ↑ Al-Shemari H, Bossé Y, Hudson TJ, Cabaluna M, Duval M, Lemire M, Vallee-Smedja S, Frenkiel S, Desrosiers M (2008). "Influence of leukotriene gene polymorphisms on chronic rhinosinusitis". BMC Med. Genet. 9: 21. doi:10.1186/1471-2350-9-21. PMC 2292155. PMID 18366797.
- ↑ Oakley GM, Curtin K, Orb Q, Schaefer C, Orlandi RR, Alt JA (2015). "Familial risk of chronic rhinosinusitis with and without nasal polyposis: genetics or environment". Int Forum Allergy Rhinol. 5 (4): 276–82. doi:10.1002/alr.21469. PMID 25677865.