ABSTRACT Chronic rhinosinusitis (CRS) is a persistent inflammatory condition involving the nasal and paranasal mucosa. It is the most prevalent chronic condition in the United States. Sinonasal inflammation is also a common clinical presentation in a variety of systemic conditions. The etiology of CRS is complicated as a variety of extrinsic and intrinsic factors are frequently involved. Extrinsic factors include microbial infections that trigger abnormal immune responses. Intrinsic factors may predispose an individual to infection or exaggerated inflammatory responses. Several systemic conditions such as cystic fibrosis (CF), primary ciliary dyskinesia (PCD), asthma, immunohyper-responsiveness, and immunodeficiencies illustrate the role of genetic abnormalities in the development of CRS. Both common and rare genetic variants have been found in an association with CRS. A role for genetic factors is also supported by the demonstration of CRS clustering in families. Although the majority of CRS cases are considered to be idiopathic, the pathological evidence suggests that the chronic condition could be an overlapped presentation of multiple underlying mechanisms. Systemic conditions may have an impact on the incidence, severity, prognosis, or treatment of patients with CRS. Evaluation for underlying conditions may help the otolaryngologist manage the symptoms of CRS and optimize therapy.
Article: Effects of manual therapy on craniofacial pain in patients with chronic rhinosinusitis: a case series.[show abstract] [hide abstract]
ABSTRACT: Chronic rhinosinusitis (CRS) is thought to develop through an inadequate drainage of nasal and sinus secretions and perpetuated by local mechanical and autonomic nervous system factors. Manual therapy may have an effect on these factors providing symptomatic relief of CRS symptoms. The purpose of this prospective case series was to report the results of manual therapy on a set of patients with craniofacial pain and a diagnosis of CRS. Fourteen consecutive patients presenting with a primary report of craniofacial pain and a diagnosis CRS completed self-report questionnaires including the Sinonasal Assessment Questionnaire, Rhinosinusitis Task Force, visual analog scale for craniofacial pain, and pressure pain threshold over 4 sinus points on the face. Patients were seen once a week for 7 consecutive weeks and completed all outcome measures at baseline and subsequent weekly sessions. They received manual therapy interventions only on the second, third, and fifth weekly sessions. No significant changes in outcome measures were observed from baseline to 1 week, where no intervention was applied. Significant improvements were observed on all outcome measures (Ps ≤ .015) for pre- and post-first treatment session, as well as from baseline to 7 weeks (Ps < .001). All patients exhibited a significant decrease in craniofacial pain and increased pressure pain thresholds and reported less severity of their symptoms. Patients with craniofacial pain and CRS who were treated with manual therapy demonstrated improvements in all outcome measures only after each treatment session. Our results suggest that manual therapy treatment could be considered as an appropriate alternative treatment of CRS.Journal of manipulative and physiological therapeutics 01/2012; 35(1):64-72. · 1.06 Impact Factor