Chronic sinusitis is a frequently seen and debilitating disease, affecting about 30 million patients in the USA, and approximately 6 billion dollars is spent annually on treating the condition. Sinusitis is defined as inflammation of the mucosa of the paranasal sinuses and the nasal cavity. Etiologies of sinusitis can be classified into three broad categories: environmental (pollution/allergies, viral URIs), systemic (diabetes, HIV), and host issues (autoimmune diseases, cystic fibrosis). Regardless of the inciting event(s), the mucosal inflammation leads to obstruction of the sinus ostia, stasis of secretions, and often a bacterial infection. Sinusitis is usually diagnosed by a symptom complex that includes congestion, facial pressure (not headache), purulent or discolored rhinorrhea, postnasal discharge, and occasionally anosmia. Fever, if it does occur, is usually low grade. The causative organisms in the acute setting are usually Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella cattharalis. Accurate diagnosis is often quite difficult since viral URIs and allergic rhinitis can often present with the same symptoms, leading to inappropriate use of antibiotics.

Sinusitis is a medical disease and initially should be treated as such. Treatment involves antibiotics, mucolytic agents/decongestants, and steroids for a minimum of 2 weeks. Adjuvant therapies such as hot steam or nasal saline irrigations provide symptomatic relief but have not been shown to expedite bacterial clearance. While most cases of acute sinusitis resolve completely, the inflammation persists in certain subsets of patients, leading to chronic symptoms (CRS), recurrent episodes of acute sinusitis, or the occasional development of inflammatory polyps.