Chronic Rhinosinusitis Pathophysiology and Surgical Interventions
Summary
Chronic rhinosinusitis is characterised by persistent inflammation of the nasal and paranasal sinus mucosa lasting more than 12 weeks. Its pathophysiology reflects a complex interplay of epithelial barrier dysfunction, aberrant immune responses, microbial biofilms and tissue remodelling. Disruption of mucociliary clearance and persistent inflammatory cascades result in mucosal thickening, polyp formation and underlying bone changes termed osteitis. Endotypes vary according to dominant immune cell profiles, most notably eosinophilic and neutrophilic patterns, which influence clinical phenotype, prognosis and response to therapy. When medical management—including topical and systemic corticosteroids, saline irrigation and antibiotics—fails to control symptoms or restore sinus ventilation, surgical intervention becomes necessary. Modern endoscopic sinus surgery techniques aim to re-establish drainage pathways, preserve mucosal integrity and minimise collateral trauma. Adjunctive technologies such as image-guided navigation, balloon sinuplasty and intraoperative drug delivery seek to reduce recurrence rates by targeting underlying drivers of inflammation and osteogenesis. A more precise understanding of tissue remodelling and local drug deposition promises to refine patient selection and improve long-term outcomes.
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Chronic Rhinosinusitis Pathophysiology and Surgical Interventions publication trend
The graph below shows the total number of articles in chronic rhinosinusitis pathophysiology and surgical interventions across all publications each year (not limited to Nature Index journals).
Technical terms
Chronic rhinosinusitis: Inflammation of the nasal and sinus mucosa lasting longer than 12 weeks.
Biofilm: Structured bacterial communities adhering to mucosal surfaces, resistant to host defences and antibiotics.
Osteitis: Inflammatory remodelling of underlying sinus bone associated with chronic mucosal disease.
Endoscopic sinus surgery: Minimally invasive technique to restore sinus ventilation and drainage using nasal endoscopes.
Balloon sinuplasty: Dilation of sinus ostia using inflatable catheter balloons to improve drainage without tissue removal.
Mucociliary clearance: Coordinated movement of cilia and mucus to remove pathogens and debris from the sinonasal tract.
References
- Preliminary study on AI-assisted diagnosis of bone remodeling in chronic maxillary sinusitis. BMC Medical Imaging (2024).
- Alleviation of Surgery-Induced Osteitis in Sinonasal Cavity by Dexamethasone-Loaded Poly(lactic-co-glycolic acid) (PLGA) Microparticles with Strong Calcium-Binding Affinity. Pharmaceutics (2022).
- The Impact of Spray Cryotherapy on Lesion-Induced Osteitis in a New Murine Experimental Model. Medicina (2023).
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