Evidence Based Review of Sinusitis Classification Pathophysiology Diagnosis and Management
Keywords:
sinusitis, rhinosinusitis, chronic rhinosinusitis, acute bacterial rhinosinusitis, nasal polyps, endoscopic sinus surgery, biologicsAbstract
Sinusitis, more accurately termed rhinosinusitis because inflammation of the nasal cavity and paranasal sinuses usually coexists, is one of the most frequent upper airway disorders encountered in primary care, pediatrics, allergy, and otorhinolaryngology. It is traditionally classified by duration into acute rhinosinusitis, recurrent acute rhinosinusitis, and chronic rhinosinusitis, and by phenotype into disease with or without nasal polyps. Although most acute episodes are viral and self-limiting, a smaller proportion progress to acute bacterial rhinosinusitis, where diagnostic accuracy is essential to avoid unnecessary antibiotic exposure and antimicrobial resistance. Chronic rhinosinusitis is a heterogeneous inflammatory syndrome lasting at least 12 weeks and requiring objective evidence of mucosal disease on nasal endoscopy or computed tomography. Current evidence indicates that chronic disease is not simply a persistent infection; rather, it reflects complex interactions among epithelial barrier dysfunction, impaired mucociliary clearance, microbial dysbiosis, type 1, type 2, or type 3 immune pathways, allergy, asthma, aspirin-exacerbated respiratory disease, environmental exposures, and host genetic susceptibility. This review summarizes contemporary evidence on sinusitis epidemiology, classification, pathophysiology, diagnostic work-up, and treatment. A narrative review methodology was used to synthesize international guidelines, systematic reviews, randomized trials, and high-impact observational studies published mainly between 2004 and 2026. Evidence-based management emphasizes symptomatic treatment, saline irrigation, intranasal corticosteroids, careful selection of antibiotics in probable bacterial disease, short courses of systemic corticosteroids in selected chronic rhinosinusitis with nasal polyps, endoscopic sinus surgery for medically refractory disease, and biologic therapies for severe uncontrolled type 2 chronic rhinosinusitis with nasal polyps.
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