Purpose of review: To discuss the systemic conditions that may impact the incidence, severity, prognosis, or treatment approach in patients with chronic rhinosinusitis.
Recent findings: Patients with allergic rhinitis do not necessarily have more severe chronic rhinosinusitis as assessed by symptom scores, nasal endoscopy, or computed tomography staging. However, at least in pediatric patients with chronic rhinosinusitis who undergo surgery, consideration of allergy and allergy treatment appears to improve surgical results. Patients with aspirin sensitivity have a more severe disease, but benefit from surgical treatment to the same degree as non-aspirin-sensitive patients with chronic rhinosinusitis. Surgical treatment of polypoid rhinosinusitis in cystic fibrosis patients improves symptoms, and aggressive surgical opening of sinus cavities may provide long-lasting benefit, though polyps will regrow in most patients, and many will require repeat surgery. Rhinosinusitis is among the most common infectious complications of humoral immunodeficiency, and humoral immunodeficiency is not uncommon in patients with refractory chronic rhinosinusitis. Patients with granulomatous disease causing rhinosinusitis, such as Wegener's granulomatosis, appear to suffer from a symptom burden that is equivalent to the broader population of chronic rhinosinusitis patients.
Summary: Systemic disease conditions influence the incidence, treatment, and severity of chronic rhinosinusitis. Specific diagnosis of these contributing conditions will facilitate appropriate treatment.