Pathogenesis, diagnosis and treatment strategies for rhinosinusitis and related diseases

Rhinosinusitis (RS) is caused by genetic, anatomical, immunological, and metabolic factors in host and external exposure factors.RS causes unpleasant symptoms such as nasal drip, postnasal drip, nasal congestion, loss of smell and flavor, headache, facial pain and pressure, and consequently results in sleep disorders, decreased productivity, inhibition of social behavior, decreased quality of life, and economic burden.Therefore, it is necessary to accurately understand the pathogenesis of RS and provide appropriate treatment.Depending on the clinical course of RS, acute RS (ARS) is defined when cured within four weeks from onset, and chronic RS (CRS) is when persists for more than 12 weeks.Detailed interviews are useful for not only understanding the pathogenesis but also confirming patients' actual needs.Clinical diagnostic scoring systems are often used in medical treatment.However, some of the scoring systems that are widely used have many evaluating graded-scores and are not suitable for Japanese.Thus, we have proposed two questionnaire scoring systems for Japanese nasal symptoms questionnaire (NSQ) and self-administered odor questionnaire (SAOQ) .When diagnosing, we should be aware of odontogenic lesions in unilateral RS and related diseases with systemic type 2 inflammation, such as bronchial asthma and vasculitis in bilateral RS.Particularly, in CRS, it is critical for treatment to diagnose whether the patient fulfill the diagnostic criteria for ECRS that indicates a type 2 inflammation dominant.A goal of treatment for RS is to suppress acute inflammation by using antibiotics and aeration of the middle nasal meatus for ARS, and to stably improve the condition and prevent recurrence without using systemic steroids for CRS.Our therapeutic strategy for CRS with nasal polyps (CRSwNP) is to first perform ESS and to select steroids, followed by biological agents for postoperative recurrence.We aim to improve therapeutic outcomes by setting treatment goals and providing appropriate treatment interventions from an early stage.In this review, the pathogenesis, diagnosis, and treatment of RS and related diseases are mentioned and discussed from the otolaryngological perspective.