Pathophysiology of Chronic Rhinosinusitis without Nasal Polyp and Met-analysis of its Pharmaceutical Options

Abstract

Summary C hronic rhinosinusitis without nasal polyp is a chronic disease with its symptoms consisting of facial pain, facial pressure, persistent nasal obstruction, hyposmia and posterior nasal discharge, it is a prevalent disease and has a significant impact on the quality of life and health care expenses. This disease is characterized by chronic inflammation in the mucous membrane of the nose and sinuses with a continuation of the previous symptoms for more than 12 weeks. Patients who suffer from chronic sinus infections scores significantly lower values on measures of physical pain and social functioning than do those with angina, back pain, congestive heart failure, disease, congestive heart failure, coronary artery disease and chronic obstructive pulmonary disease. And the treatment of chronic sinusitis that can improve the quality of health status and dramatically reduces fatigue and physical pain. National Ambulatory care data 2006-2010 revealed that chronic sinus infections accounted for more antibiotic prescriptions in the outpatient diagnosis than any other, and represent 11% of all primary health care visits related antibiotics. Chronic rhinosinusitis is of 2 types, chronic rhinosinusitis without nasal polyp and chronic rhinosinusitis with nasal polyp the difference between them is the result of the difference in the pattern of T cells and the cells responsive inflammatory, and remodeling and production of immune globulin, chemokines and eicosanoide production, and the role of microorganisms. Predisposing factors for chronic rhinosinusitis without nasal polyp include: anatomical changes, air pollution , genetic factors underlying such primary ciliary dyskinesia (cystic fibrosis), active and passive cigarette smoking, gastrointestinal reflux (laryngopharyngeal reflux). As a conclusion 69.3% were able to avoid surgery using single modality medical treatment while Lal et al stated that 71.3% of patients with chronic rhinosinusitis were able to avoid surgery using multimodality medical therapy. Surgery in chronic rhinosinusitis without nasal polyp is limited to failure of medical treatment, prominent anatomical abnormalities that interferes with normal mucociliary clearance. 1609 patients were analyzed using different drug treatments which are divided into 8 different groups, each group with a different medication.