Letters

Sinusitis and rhinitis, or rhinosinusitis?

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6980.670a (Published 11 March 1995) Cite this as: BMJ 1995;310:670
  1. Julian Rowe-Jones,
  2. Ian Mackay
  1. Senior registrar Consultant Department of Otorhinolaryngology, Charing Cross Hospital, London W6 8RF

    EDITOR,—Kathryn Evans's comprehensive review of sinusitis considers chronic sinusitis to be an infective condition and one that should be distinguished from rhinitis.1 The distinction between rhinitis and sinusitis is an artificial one. Nasal mucosa is contiguous with sinus mucosa, and pathology of one can be expected to affect the other.2 The same aetiological classification should be considered for chronic sinusitis as for chronic rhinitis.3 Consequently, while chronic sinusitis may be due to infection, with or without predisposing factors, it may be due solely to allergy, structural abnormalities causing epithelial opposition with secondary neurogenic oedema,4 or a large group considered together at present as “other” disorders. This group includes mucosal hyperreactivity, whether intrinsic or resulting from environmental agents and idiopathic causes, as may also affect the lower respiratory tract. In particular, as well as in the thickened bronchial mucosa of people with asthma, eosinophils have been demonstrated in nasal mucosa from patients with non-allergic, non-infective rhinitis and in sinus mucosa from patients with chronic sinusitis with and without polyps. Of the first 800 patients in our series undergoing endoscopic sinus surgery for chronic rhinosinusitis, 325 (41%) had concurrent intrinsic lower respiratory tract disease, of whom 194 (60%) had asthma. All these conditions may predispose to infection but often cause chronic sinonasal symptoms and abnormalities in computed tomograms without infection.

    We do not distinguish rhinitis from sinusitis and we diagnose patients with more than eight weeks of sinonasal symptoms as having chronic rhinosinusitis. This is a spectrum of disease, ranging from predominantly rhinitis to predominantly sinusitis with or without polyposis. Not all patients will present with purulent rhinorrhoea, and we do not advocate routine use of antibiotics. The recurrence of mucosal pathology in 23% of non-polypoid cases of chronic rhinosinusitis after restoration of normal sinus ventilation and mucociliary clearance with medical treatment and functional endoscopic surgery5 suggests that factors other than infection are solely responsible in many cases.

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