Current Understanding of the Acute Exacerbation of Chronic Rhinosinusitis.

Dawei Wu,Benjamin Saul Bleier,Yongxiang Wei

doi:10.3389/fcimb.2019.00415

Abstract

Background: Acute exacerbations of chronic rhinosinusitis (CRS) have been increasingly recognized as an important disease entity with a significant impact on the quality of life. There is a growing amount of research on the etiopathogenesis and management of acute exacerbations of CRS. This review aims to summarize the current literature and provide an overall understanding of acute CRS exacerbations.Methods: A related literature review with the key terms of “chronic rhinosinusitis” and “exacerbation” was performed using PubMed.Results: There is no consensus definition of the acute exacerbation of CRS. Impaired mucociliary clearance, atrophic rhinitis, and immunologic changes are important predisposing factors for acute CRS exacerbations. Current evidence supports the role of the transient viral infection as the initial inflammatory stimulus in the pathogenesis of acute CRS exacerbations. Secondary bacterial infection or microbial community dysbiosis within the sinonasal cavity is the main event during the acute exacerbation of CRS. Distinct changes in local and systemic immune responses during exacerbation provide new insights into the pathophysiology of CRS exacerbation. Although current guidelines suggest the use of short-term antibiotics in patients with acute CRS exacerbation for symptomatic relief, evidence-based treatment recommendations for acute CRS exacerbation are still lacking, and large-high-quality RCTs are required.Conclusion: There have been significant advances in understanding the etiology and immunological feathers of acute CRS exacerbation. Nevertheless, consensus definition, diagnostic criterion, biomarkers to differentiate acute CRS exacerbation from CRS, assessment of disease severity, and evidence-based treatment options for acute CRS exacerbation are still lacking.

Highlights

Chronic rhinosinusitis (CRS) is a highly heterogeneous upper airway disease (Orlandi et al, 2016), which affects about 11–12% of adults in western countries (Hastan et al, 2011; Hirsch et al, 2017) and ∼8% of the general population in China (Shi et al, 2015)
As a distinct form of CRS, acute CRS exacerbation can be triggered by viruses and follows with bacterial infections, which might be the result caused by the imbalance among the bacterial species within the sinus cavities
BB and YW reviewed and revised this manuscript

Summary

Introduction

Chronic rhinosinusitis (CRS) is a highly heterogeneous upper airway disease (Orlandi et al, 2016), which affects about 11–12% of adults in western countries (Hastan et al, 2011; Hirsch et al, 2017) and ∼8% of the general population in China (Shi et al, 2015). It significantly impairs quality of life due to the chronic symptoms (Hoehle et al, 2016) and acute exacerbations of CRS (Phillips et al, 2017). This review aims to summarize the current literature and provide an overall understanding of acute CRS exacerbations

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Results

Conclusion