Chronic Rhinosinusitis with and Without Nasal Polyps

Consensus definitions for chronic rhinosinusitis (CRS) began to emerge in 2003 in order to address the need for uniformity within clinical research trials, to target various potential causes of the disease, and to better elucidate effective prevention and treatment plans [1]. At this point in time, two clinically distinct patterns of disease had been recognized. The first pattern was of CRS that occurred in patients who concomitantly suffered asthma. This was thought to be supportive of the “one-airway disease” hypothesis and implicated a more systemic inflammatory process broadly involving airway respiratory epithelium [2]. This population of patients was also more likely to manifest allergies, bilateral sinus involvement, and nasal polyposis. The second pattern of disease differed from the first, most significantly in that patients suffered no other evidence of airway disease. The pattern of sinus involvement could be asymmetric, and an association with dental disease or anatomic variants was noted. The lack of consensus around a single definition at the time highlighted the difficulty in consolidating these observations of CRS as a single disease entity, and supported the concept that CRS may exist more as a syndrome of several underlying etiologies [2].