Rhinosinusitis & Nasal Polyps
Rhinosinusitis & Nasal Polyps
What is rhinosinusitis and how do we get it?
Rhinosinusitis is an inflammation of the lining of the nasal passages and paranasal sinuses. There are several forms of rhinosinusitis. These include: acute, recurrent acute and chronic. Chronic rhinosinusitis may be seen with or without nasal polyposis.
Nasal Polyps are benign tumors of the upper airway which are often time associated with many eosinophils (a type of white blood cell). They are not believed to have any malignant potential. There are many conditions which are associated with their formation and unfortunately in a given person, it may be impossible to determine what the cause of the polyps is. Most often nasal polyps tend to recur. The speed with which they recur can be control with ongoing medical therapy. Systemic steroids are often very effective in reducing their size but only temporarily. Rarely aggressive sinus tumors or malignancies can appear within polyps.
Most episodes of rhinosinusitis are believed initiated with viral upper respiratory tract infections (eg the common cold or flu) Those with a genetic predisposition towards allergy, immune dysfunction, aspirin sensitivity, and chronic rhinosinusitis seem to be most susceptible to the long term effect of sinus infections.
Swelling around the small openings to the sinuses caused by environmental irritants, viruses, allergy, or other conditions can result in rhinosinusitis. When the blockage occurs, inflammation of the sinus lining can disable the cilia and the drainage of the mucus blanket. The mucus in the nose and sinuses can secondarily become infected by bacteria or fungi.
Super-antigen Hypothesis
It has been demonstrated that certain toxins produced by Staph aureus called “super-antigens” can stimulate and “short circuit” our immune response. The end result is that certain white blood cells called eosinophils are produced in abnormal quantities and sent from the bone marrow to the sinuses where they release toxic substances. Eosinophils sustain the inflammation seen in chronic rhinosinusitis with or without polyps.
Fungus Induced Rhinosinusitis Hypothesis
Eosinophils seem to have a primary function of killing macro organisms such as worms and fungi. Thus, fungi also attract eosinophils and appear to play an important role in chronic rhinosinusitis.
Biofilm Hypothesis
Staph. species, Pseudomonas and Candida are also known to form protective covering over themselves in a “biofilm” which can tightly adhere to surfaces.
Environmental pollutants in the air, such as cigarette smoke, can cause increased irritation of the nasal and sinus passages, particularly in people with hypersensitive nasal lining (mucosa). We are also becoming more aware of the effects of both general outdoor and indoor pollution. Exposure to chemicals may also be a problem for sensitive individuals.
If you have an allergic predisposition, your nose may react to allergy-inducing substances in the air, such as dust or mold. Allergic nasal and sinus swelling may in turn lead to sinusitis. Food allergies (or sensitivities) can also be an unrecognized cause of nasal congestion and swelling. It is possible that Gastroesophageal Reflux Disease (GERD) may cause symptoms of rhinosinusitis, including chronic cough, post-nasal drainage or a tightness sensation in your throat upon swallowing.
Lastly, autoimmune conditions can increase your susceptibility to sinus infections. Emotional stress can result in swelling of the nasal lining and certain medications can have a similar effect. If you have diabetes, high blood sugar can make your body more prone to infections.
