Most patients with ‘chronic’ sinus disease usually have disorders of sinus inflmmation or mechanical dysfunction (loss of mucus clearance). Chronic sinusitis is rarely an ‘infectious’ condition. Although bacteria take advantage of dysfunctional sinuses and create exacerbations, simplying taking antibiotics rarely solves this issues. In this lecture from our 2019 Sydney Sinus Surgery course, we review our current approach to ‘inflammatory’ sinus diseaes, the current phenotypes that we identify and how we approach the condition for patients.

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Classic descriptions of chronic sinusits discuss simplistic origins of sinus ostia occulsion (thats the opening of the sinuses – there are 3 main openings on each side) and then secondary infection. While this type of sinus disease does occur, as below, it is very limited and usually unilateral, realtively uncommon and easily treated:

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Examples of simple sinus disease that usually has very focal symptoms (ie not bilateral). Only 5-6 codes would typically describe the operation required to

Chronic sinusitis is more commonly bilateral diffuse and has inflammatory origins

Most patients with chronic symptoms will likely have diffuse changes and this is usually a marker of inflammatory disease. The lecture describes how we currently approach these patients:

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These patients have extensive disease. The disease process here is diffuse and bilateral. This is not a simple ‘plumbing’ problem or anatomical obstruction. Complex sinus surgery is required here and up to 15 codes might describe such an intervention.

Subsequently, key research and clinical consensus groups have promoted that we better describe chronic sinusitis and have promoted a better understanding of the concept of ‘diffuse’ sinus disease that usually has inflammatory origins:

sinus specialist harvey sydney sinusitis classification

Primary CRS Classificiaton by EPOS2020

What are the features of differing types of inflammatory sinisitis?

Appreciating the underlying inflammatory subtype of sinus disease is critical to successful longterm control. Dr Jessica Grayson has published a terrific manuscript that summarises this process. The key table of clinical features are:

inflammatory subtypes of chronic sinusitis

Journal of Otolaryngology – Head & Neck Surgery, 2019, doi:10.1186/s40463-019-0350-y


If you have chronic sinusitis, an abnormal CT scan of the sinuses, prior surgery or treatment that hasn’t worked then please contact us