The first thing to note is that there is a poor correlation between symptoms and severity of the disease. Typical symptoms of chronic sinusitis include:

• Anorexia 
• Chronic unproductive cough common in children
• Dental pain often localized to the upper teeth
• Fatigue
• Exacerbation of asthma 
• Facial fullness, discomfort, pain, and headache (more with nasal polyposis) 
• Halitosis 
• Fever of unknown origin 
• Hyposmia or anosmia (more common with nasal polyposis) 
• Malaise 
• Nasal obstruction, blockage, congestion, stuffiness which may lead to mouth breathing
• Nasal discharge which may be watery of viscous. 
• Postnasal drip 
• Sneezing 
• Sore throat 
• Stuffy or blocked ears 
• Unpleasant taste 
• Visual disturbances including eye swelling

Obtain the following in the history:

• Duration of symptoms 
• Environmental living conditions and exposure to pollutants
• Factors which exacerbate the illness
• Factors that relive the symptoms
• Current use of medications, herbs and supplements
• Other medical problems (eg allergy, asthma, immunosuppression)
• Prior nasal and sinus surgery
• Prior treatments for sinusitis
• Results of previous imaging test
• Smoking

Physical examination

The physical exam is best performed with the use of a topical nasal decongestant like oxymetazoline as this can help with visualization. The exam must be done in a systemic manner and one needs to assess the turbinates, nasal septum, and middle meatus. Rhinoscopy should be conducted with and without a topical decongestant. During the exam one needs to identify the following?

• Abnormal features of nasal mucosa, like color or condition
• Any nasal mass or irregular surface
• Assess integrity of hard plate
• Bleeding, ulceration or diffuse areas of hemorrhage
• Dry crusts or nasal septum perforation should lead one to suspect Wegener granulomatosis
• Excessive secretion or dryness of nasal mucosa
• Hypertrophy of turbinates
• Look at condition of dentition and dental caries
• Look for evidence of purulent secretions and post nasal drip
• Palpation of the sinus for tenderness or swelling
• Presence of any anatomical obstruction, septal deviation
• Vascular malformations

Other organs systems to examine include the ears for otitis media or middle ear fluid collection and the eyes for cojunctival congestion, lacrimation, proptosis and visual acuity.

• Fatigue

  ] Sinusitis - Symptoms The basic symptoms of chronic and acute sinusitis are the same: headaches, a blocked and congested nose, fatigue and the feeling of dizziness. [ more ] Chronic sinusitis - Treatment Which treatments help whith chronic sinusitis [chronic-sinusitis.co.uk]

  Are You Fatigued and Tired of Your Sinus Symptoms? See If You Have This Common Bacteria. (It just might be the link to set your sinuses and other symptoms free!) These Top Sinus Issues are all Linked to this Culprit: 1). Fatigue 2). [sinussurvival.com]

  Fatigue Partially a result of the aforementioned lack of sleep and partially a result of your body’s energy being used to fight off the sinus infection, people with chronic sinusitis are also chronically fatigued, which is usually accompanied by some [breatheamerica.com]

  Halitosis, fatigue, dental pain, cough, ear pressure, fullness. The use of endoscope during surgery of nose & para nasal sinuses improves visualization enable greater preservation of normal structures and reduces the necessity for wide exposure. [ncbi.nlm.nih.gov]

  Alexander Chester has shown that chronic nasal congestion can actually trigger chronic fatigue, and 2 new studies actually address CFS/FMS with sinus surgery (see " Sinus Surgery in Fibromyalgia (FMS) and Chronic Fatigue "). [vitality101.com]

• Hodgkin Lymphoma

  Phase I/II trial of epratuzumab (humanized anti-CD22 antibody) in indolent non-Hodgkin's lymphoma. J Clin Oncol 2003; 21:3051–3059. 50. Herman SE, Gordon AL, Hertlein E, et al. [ekjm.org]

• Cough

  Although "runny nose" had a direct correlation with improvement, more severe "sadness" and "cough" scores had a negative impact on degree of improvement. [ncbi.nlm.nih.gov]

  Banerji, Aleena, MD Clinical Interests Drug hypersensitivity Angioedema Asthma Immunodeficiency Rhinosinusitis Cough Anaphylaxis Eosinophilic disorders Food sensitivity Dermatitis Urticaria Board Certifications Allergy & Immunology, American Board of [massgeneral.org]

  I have a smelly yellow nose, and I cough because of the ruby. Also, because of nasal congestion, I cannot smell well and my appetite is lost. [youtube.com]

  A regular cold usually causes a runny or stuffy nose and cough, but if it lasts longer than 10 days it may be sinusitis. [soundhealthservices.com]

• Nasal Congestion

  Nasal Obstruction and Congestion Nasal congestion (obstructed nose or diminished airflow through the nose) is certainly uncomfortable but this can also lead to many dental and medical problems. [arizonasinus.com]

  A 44-year-old man attended our outpatient clinic with complaints of headache, nasal congestion, and postnasal drainage. [ncbi.nlm.nih.gov]

  If you have had nasal congestion and drainage for more than 3 months, you may have chronic sinusitis. The primary symptoms are nasal congestion, stuffiness, mouth breathing, and snoring. Nasal blockage often results in loss of taste and smell. [richmondent.com]

  Chronic Nasal Congestion An estimated 35 million people in the United States suffer from chronic nasal congestion, and headaches and facial pain associated with the condition. It is a common and debilitating problem for children and adults. [wakemed.org]

  Symptoms of chronic sinusitis include nasal congestion. I have a smelly yellow nose, and I cough because of the ruby. Also, because of nasal congestion, I cannot smell well and my appetite is lost. [youtube.com]

• Nasal Discharge

  Chronic rhinosinusitis is diagnosed by the presence of two or more of the following factors facial congestion/fullness, nasal obstruction, nasal discharge or discolored post nasal drainage, hyposmia/anosmia or one major and two of the following minor [ncbi.nlm.nih.gov]

  Common Symptoms of Sinusitis Common symptoms of both acute and chronic sinusitis include, but are not limited to: Facial pain, pressure, swelling, or tenderness Nasal obstruction or blockage Nasal discharge that is thick and yellow or greenish in color [virginia-ent.com]

  Signs and symptoms include headache, nasal discharge, swelling in the face, dizziness, and breathing difficulties. [fpnotebook.com]

  […] to socialize Nasal discharge that isn't clear Having problems sleeping Feeling moody and miserable Avoiding social situations TYPES OF SINUSITIS There are two kinds of sinusitis. [medtronic.com]

• Postnasal Drip

  The positive finding rate of postnasal drip by endoscopic examination was also significantly lower in the 6-month treatment group at 12 months after surgery. [ncbi.nlm.nih.gov]

  Sinusitis is an inflammation of the lining of the sinuses and nose that causes postnasal drip or yellow-green discharge from the nose. [allergytampa.com]

  Learn More about Balloon Sinuplasty™ A Guide to Post Nasal Drip Postnasal drip is so irritating. That flow of thick or thin mucus that we have all had from one time or another. But constant or chronic postnasal drip isn’t normal. [coloradoent.com]

• Anosmia

  BACKGROUND: Chronic sinusitis and nasal polyps with subsequent nasal blocking, anosmia, and relapsing infections are frequent in the rhinological practice. [ncbi.nlm.nih.gov]

  Patients may present with symptoms of sinusitis such as nasal obstruction, nasal discharge, facial pain, headache, halitosis, anosmia, etc. [radiopaedia.org]

  Anorexia Chronic unproductive cough common in children Dental pain often localized to the upper teeth Fatigue Exacerbation of asthma Facial fullness, discomfort, pain, and headache (more with nasal polyposis) Halitosis Fever of unknown origin Hyposmia or anosmia [symptoma.com]

  Read information about Anosmia or decreased sense of smell. [melbentgroup.com.au]

• Thrombosis

  Mucormycosis of the nasal cavity and paranasal sinuses is an aggressive, life-threatening condition characterized by fulminant destruction of soft tissues and bone, vascular invasion, and thrombosis. [ncbi.nlm.nih.gov]

  Frequency of deep vein thrombosis in patients with patent foramen ovale and ischemic stroke or transient ischemic attack / H. Lethen, F. A. Flachskampf, R. Schneider et al. // Amer. J. Cardiol. - 1997. - Vol. 80. - P. 1066-1069. 43. Lin, M. C. [cardiology-journal.com]

  Complications In children chronic sinusitis may result in the adenoiditis, purulent otitis media, laryngitis and dacryocystitis Orbital cellulitis Subperiosteal abscess Orbital abscess Cavernous sinus thrombosis Epidural abscess Meningitis Brain abscess [symptoma.com]

  The main complication of sinusitis is local spread of bacterial infection, causing periorbital or orbital cellulitis, cavernous sinus thrombosis, or epidural or brain abscess. [msdmanuals.com]

  Sinusitis may extend to the central nervous system, where it may cause cavernous sinus thrombosis, retrograde meningitis, and epidural, subdural, and brain abscesses.[20] Orbital symptoms frequently precede intracranial spread of the infection. [en.wikipedia.org]

• Urticaria

  Banerji, Aleena, MD Clinical Interests Drug hypersensitivity Angioedema Asthma Immunodeficiency Rhinosinusitis Cough Anaphylaxis Eosinophilic disorders Food sensitivity Dermatitis Urticaria Board Certifications Allergy & Immunology, American Board of [massgeneral.org]

• Facial Pain

  After recovery, she developed sinus symptoms of facial pain, green nasal discharge and bilateral hearing loss. ENT review revealed bilateral otitis media with effusion. Flexible naso-endoscopy found a stent fragment lodged in the nasopharynx. [ncbi.nlm.nih.gov]

  Patients will experience mucopurulent drainage, nasal congestion, facial pain-pressure-fullness, or a decreased sense of smell. [mountsinai.org]

  Sinusitis, also known as sinus infection or rhinosinusitis, is a very common condition where the paranasal sinuses are inflamed, causing congested nose, headache and facial pain. Paranasal sinuses are air cavities in the bones of the skull. [youtube.com]

• Sinus Pain

  However, patients may have exacerbations of acute sinusitis superimposed on the chronic disease, which may cause sinus pain, fever, and malaise. [ncbi.nlm.nih.gov]

  […] and pressure Headache and sinus pain Nasal congestion Thick, colored drainage from the nose Thick mucus draining down the back of the throat (postnasal drainage) Loss of smell Fever Cough Sore throat Diagnosing chronic sinusitis Your doctor will ask [saintlukeshealthsystem.org]

  Sinus Infection 6 Natural Remedies for Pain and Pressure From Sinus Infections Before turning to antibiotics, try these sinus pain remedies to help ease achiness and nasal congestion. [everydayhealth.com]

  […] fungal sinusitis Nasal infection Nasal sinus abscess Nasal sinus disease Nasal sinus empyema Pain of respiratory structure Sinus headache Sinus pain Sinusitis Sinusitis with nasal polyps Sinusitis, chronic Clinical Information Inflammation of the paranasal [icd10data.com]

• Headache

  BACKGROUND: Headache is a common complaint in emergency department (ED) patients. Nearly 15% of ED headache patients will have brain computed tomography (CT) done. One frequent finding on these scans is "chronic sinusitis." [ncbi.nlm.nih.gov]

  Approach to acute headache in adults. Am Fam Physician. 2013;87(10):682-687. Headache. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 24, 2014. Accessed September 29, 2014. Sinus headache. [cancercarewny.com]

  ] Sinusitis - Symptoms The basic symptoms of chronic and acute sinusitis are the same: headaches, a blocked and congested nose, fatigue and the feeling of dizziness. [ more ] Chronic sinusitis - Treatment Which treatments help whith chronic sinusitis [chronic-sinusitis.co.uk]

• Sinus Headache

  National Headache Foundation website. Available at: http://www.headaches.org/2007/10/25/sinus-headache. Accessed September 29, 2014. Sinus headaches. American Academy of Otolaryngology website. Available at: http://www.entnet.org/?q=node/1410. [cancercarewny.com]

  CLINIC FEATURES: A 41-yr-old woman was treated for chronic sinusitis and sinus headaches. She had suffered weight loss and pain over a 2-month period. [ncbi.nlm.nih.gov]

  According to Hossein Ansari, the medical director of the Headache Centre at Neurology & Neuroscience Associates in the USA, one reason for the high rate of misdiagnosed “sinus” headaches is that most patients don't seek care from a headache specialist [health24.com]

  The Top 7 Underlying Causes of Sinusitis. by Dan Gay, CMO Sinus Survival You may be surprised to learn what’s causing your sinus headaches, sinus pressure, sinus congestion and post-nasal drip. [sinussurvival.com]

  Sinusitis can cause a variety of respiratory symptoms, including wheezing, coughing, and snoring, as well as sinus headaches. [houstonsinussurgery.com]

• Frontal Headache

  Maxillary sinusitis causes pain in the maxillary area, toothache, and frontal headache. Frontal sinusitis causes pain in the frontal area and frontal headache. [msdmanuals.com]

• Recurrent Headache

  headaches Postnasal drip Fatigue Diminished sense of smell Facial pressure Frequent episodes of infections that require antibiotics Can be exacerbated by the following: Nasal polyps, or small growths of tissue that obstruct nasal passages Respiratory [rush.edu]

Criteria to make a diagnosis of chronic sinusitis include symptoms present for 12 weeks or longer, 2 or more symptoms and CT scan showing bony changes, diffuse mucosal thickening or air fluid levels. It is important to be aware that using CT scan signs of inflammation can be seen in more than 2/5th of patients with chronic sinusitis in the absence of symptoms. Thus, making a diagnosis of chronic sinusitis on a CT scan alone is not sufficient. The imaging test must be supported with presence of clinical symptoms. CT scan is usually done in patients who fail to respond to therapy to ensure that there is no other pathology. Both plain X-rays and MRI are not recommended in routine cases because they lack specificity. Routine blood work is usually not helpful. Routine culture is not recommended. Culture may be done during endoscopy in individuals with complications like orbital infection or intracranial extension. Biopsy, allergy testing, immunoglobulin levels and sweat test to rule out cystic fibrosis may aid in diagnosis.

• Sinus Opacification

  The severity of sinus mucosal inflammation or fluid accumulation was scored as 0 (no opacification), 1 (1–49% opacification), 2 (50–99% opacification), or 3 (total opacification). Undeveloped sinuses were not scored. [journals.plos.org]

• Staphylococcus Aureus

  The most frequently found bacteria in sinuses were Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella spp. and Streptococci (pneumoniae, viridans and spp.). [ncbi.nlm.nih.gov]

  Effectiveness of topical antibiotics on Staphylococcus aureus biofilm in vitro. Am J Rhinol. 2007;21(2):149-53. [ Links ] 13. Chennupati SK, Chiu AG, Tamashiro E, Banks CA, Cohen MB, Bleier BS, et al. [scielo.br]

The aim of treatment for chronic sinusitis is to enhance drainage, decrease mucosal edema and eradicate the bacteria that are present. When the diagnosis of chronic sinusitis is made, the first step in the management is to identify the contributing factors. Allergy is frequently associated with chronic sinusitis and it may also need treatment. Experts recommend that testing for allergy may identify a subset of patients whose symptoms may respond to allergy treatment. If the patient has failed successive treatments, check the immune system for defects.

There is no cure for chronic sinusitis and hence the goal is to decrease the symptoms and minimize the complications by controlling the infectious component of the disorder [7] [8] [9] [10]. In general the treatment of chronic sinusitis is use of intranasal corticosteroids. Antibiotics may be required if there are signs of an infection. In most patients with chronic sinusitis without the presence of nasal polyps, there is an underlying infection and hence the treatment is intranasal corticosteroids combined with an antibiotic. The initial therapy is with a broad spectrum antibiotic that will target Staphylococcus aureus, gram negative organisms and anaerobes. Rarely one may need antibiotics to cover for Haemophilus influenza, Streptococcus pneumoniae and Moraxella catarrhalis.

Treatment of chronic sinusitis depends on duration and severity of symptoms plus any objective features of inflamed paranasal sinuses or the nasal mucosa. Presence of nasal polyps leads to slightly different treatment. Chronic rhinosinusitis with nasal polyps is treated with intranasal corticosteroids. Antibiotics are recommended when symptoms indicate infection (pain or purulence).

Control risk & trigger factors

• Treat upper respiratory tract infections and gastroesophageal reflux disease  
• Avoid exposure to tobacco smoke and environmental pollutants
• Allergic patients should be treated with antihistamines, cromolyn or immunotherapy
• Get control of asthma with prophylactic leukotriene inhibitors
• Symptoms may be relieved with topical decongestants, topical steroids, antibiotics, nasal saline, topical cromolyn, or mucolytics.
• Steam inhalation and nasal saline irrigation may help by moistening dry secretions, reducing mucosal edema, and reducing mucous viscosity. Patients who have facial pain, and documented purulence should be suspected of having a concomitant bacterial infection and antibiotics should be considered.

Steroids

Most trials have shown a benefit from use of steroids in chronic sinusitis. In patients with severe sinusitis with polyps which has failed to respond to intranasal steroid, a 2 week course of oral prednisone may help improve symptoms. Steroids have also been used before and after endoscopic sinus surgery with effectiveness. When starting steroids, the minimal dose of the drug must be started and the patient must be told of all the potential adverse effects.

Adjunct therapies

• Saline irrigation
• Mucolytics
• Antihistamines
• Nasal decongestant

No solid evidence that any of the above therapies work. In addition, prolonged use of nasal decongestants can lead to development of rhinitis medicmentosa.

Antimicrobial therapy

• At least 4-6 weeks of antibiotic treatment is required. Antibiotics selected should have broad spectrum coverage until culture results are available. Antibiotic therapy is continued until patient is asymptomatic, otherwise a relapse can occur. In refractory cases or in people with poor IV access, nebulized antibiotics can be administered.
• Typical antibiotics used include amoxicillin plus clavulanate, macrolide plus metronidazole, 3rd generation cephalosporin or a quinolone. MRSA coverage is essential.
• Experts recommend tailoring therapy to the clinical presentation. Patients with chronic sinusitis without nasal polyps are usually treated with a short course of prednisone and intranasal steroid.
• Patients with chronic sinusitis and nasal polyps need relief from the obstruction and improved sinus drainage. This is achieved with use of systemic steroids and sometimes surgery.

If patient fails to respond, consider other disorders like:

• Invasive fungal rhinosinusitis
• Vasomotor rhinitis
• Migraine
• Atypicla facial pain
• Trigeminal neuralgia
• TMJ syndrome

Surgical care

• Surgery is never the first choice treatment for chronic sinusitis. It is reserved for cases that have failed to respond to medical therapy and in patients with obstruction. The aim of surgery is allow for ventilation of the sinuses and correct mucosal opposition so that mucociliary clearance can be reestablished. Surgery can help remove thick and viscid secretions, and polys.
• Fungal sinusitis (with fungal balls) is resistant to medical care and usually requires surgical debridement. Role of antifungal agents in chronic sinusitis is not clear. Allergic fungal sinusitis that presents with nasal polys is treated with systemic steroids followed by surgical removal of the polyps.

Consultations

All recurrent cases of chronic sinusitis should be referred to an otolaryngologist. In addition, any ocular involvement requires consultation with an ophthalmologist. If there is poor dental hygiene or dental caries, a consultation with a dentist is recommended.

Chronic sinusitis is associated with high morbidity because of its chronicity. Despite treatment, relapses are common. The patients usually have a poor quality of life. The disorder can exacerbate asthma and if left untreated can lead to osteomyelitis, meningitis, brain abscess and ocular complications. Even though medical and surgical treatment is available, the outcomes are not always predictable or consistent. Some patients do obtain relief from symptoms, but the treatment if often for prolonged time periods.

Complications

• In children chronic sinusitis may result in the adenoiditis, purulent otitis media, laryngitis and dacryocystitis
• Orbital cellulitis
• Subperiosteal abscess
• Orbital abscess
• Cavernous sinus thrombosis
• Epidural abscess
• Meningitis
• Brain abscess
• Subdural abscess
• Sinus wall may develop osteomyelitis and mucocele formation

Finally the cost of medical care for chronic sinusitis is prohibitively expensive. Absenteeism from work is frequent leading to low productivity.

The causes of chronic sinusitis include the following:

• Dental disorders
• Immunodeficiency states
• Nasal obstruction
• Polyps
• Allergies

Common types of bacteria involved include:

• Staphylococcus aureus including MRSA
• Haemophilus influenza
• Streptococcus pneumoniae
• Streptococcus intermedius
• Pseudomonas aeruginosa
• Anaerobes

The exact role of these bacteria in chronic sinusitis is not known. Even with proper techniques of isolation, bacteria are isolated in only about 50% of patients with chronic sinusitis. The only thing certain is that bacteria can exacerbate the symptoms. Fungal agents involved include Aspergillus, Cryptococcus and Candida.

Risk factors

• Anatomical defects in the sinuses and nasal cavity
• Allergic rhinitis
• Asthma
• Nasal polyps
• Prior nasal or orotracheal intubation
• Presence of a nasal mass
• Immune defects like AIDS, deficiency of IgA [4]
• Non-allergic rhinitis
• Cystic fibrosis
• Wegener granulomatosis
• Smoking
• Environmental pollutants
• Gastroesophageal reflux disease (GERD)
• Dental disease

Chronic sinusitis is a common global medical disorder. In the US alone it is estimated that nearly one out of every seven individuals are affected. The disorder occurs in both genders and requires multiple visits to the emergency room and outpatient clinics. The chronicity of symptoms adds to a significant financial burden to the individual and the healthcare system.

In most cases, chronic sinusitis is seen in late adulthood and is now being reported in countries with high pollution like China. Damp and wet climates and places associated with higher pollen concentration also have a high prevalence. In children chronic sinusitis is more common and most likely related to prior upper respiratory tract infections [5] [6].

The pathophysiology of chronic sinusitis is not well understood. It is widely believed that presence of a bacterial infection or bacterial biofilms contribute to chronic or persistent sinus disease. The problem is exacerbated in the presence of antibiotic resistant strains of bacteria. However, the contribution of bacteria, fungi, other immunological deficits, susceptibility factors and role of environment remains unknown. It is now accepted that there is a spectrum of chronic sinusitis with various subtypes which present different pathological mechanism.

Chronic sinusitis is difficult to prevent because the actual cause is not known. However, once diagnosed patients should avoid triggers like allergens, environmental pollutants, discontinue smoking and stress. The individual should follow up with a healthcare provide to ensure that the asthma is well controlled. The earlier the symptoms are controlled, the better is the quality of life.

Chronic sinusitis is a very common medical disorder not only in the US, but globally. This inflammatory disorder affects the paranasal sinuses and is usually accompanied by varying degrees of nasal inflammation. When the condition lasts more than 12 weeks, it is considered chronic. Chronic sinusitis is classified as:

• Chronic sinusitis without presence of nasal polyps 
• Chronic sinusitis with nasal polyps 
• Allergic fungal rhinosinusitis

In the majority of cases, chronic sinusitis evolves from an acute sinusitis, but the symptoms are much intense in chronic sinusitis. Even though bacterial involvement can occur in chronic sinusitis, there are medical disorders which can present with chronic sinusitis in the absence of bacteria. These include cystic fibrosis, allergies, gastroesophageal reflux disease (GERD) or exposure to environmental agents. Fungal sinusitis can present in the same way as bacterial sinusitis but most patients tend to be diabetic, immunosuppressed or are on a prolonged course of corticosteroids. Allergic fungal sinusitis may present with nasal polyps. Chronic sinusitis is a disorder difficult to treat. Even with current day treatment, relapses are common the quality of life is poor [1] [2] [3].

Chronic sinusitis is a disorder of the nasal passages and the sinuses. It is a condition whose exact cause is unknown and it can present with a variety of symptoms that include a runny node, facial pain, fever, blocked nose, polyps, cough, and loss of weight. The diagnosis is made from a physical exam and use of a CT scan. Some people may need a endoscopy for biopsy. The treatment involves use of intranasal steroids and antibiotics. People who fail to respond need endoscopic surgery. The results of treatment are not always consistent and not everyone benefits. If left untreated, chronic sinusitis can extend to the eyes, brain and other facial areas.

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3. Georgalas C, Vlastos I, Picavet V, van Drunen C, Garas G, Prokopakis E. Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation. Allergy. 2014 Jul;69(7):828-33
4. Stevens WW, Peters AT. Immunodeficiency in chronic sinusitis: recognition and treatment. Am J Rhinol Allergy. 2015 Mar-Apr;29(2):115-8
5. Brietzke SE, Shin JJ, Choi S, Lee JT, Parikh SR, Pena M, Prager JD, Ramadan H, Veling M, Corrigan M, Rosenfeld RM. Clinical consensus statement: pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2014 Oct;151(4):542-53
6. Silviu-Dan F. Pediatric chronic rhinosinusitis. Pediatr Ann. 2014 Aug;43(8):e201-9.
7. Kang SH, Dalcin Pde T, Piltcher OB, Migliavacca Rde O. Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment. J Bras Pneumol. 2015 Jan-Feb;41(1):65-76
8. Sharma R, Lakhani R, Rimmer J, Hopkins C. Surgical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database Syst Rev. 2014 Nov 20;11:CD006990
9. Marglani O. Update in the management of allergic fungal sinusitis. Saudi Med J. 2014 Aug;35(8):791-5.
10. DeYoung K, Wentzel JL, Schlosser RJ, Nguyen SA, Soler ZM. Systematic review of immunotherapy for chronic rhinosinusitis. Am J Rhinol Allergy. 2014 Mar-Apr;28(2):145-50.