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Chronic Rhinosinusitis Definition clinical:

Rhinosinusitis: Classification. Based on temporal nature:Acute (<4 weeks)Subacute (4-12 weeks)Recurrent acute (> 4 episodes per year)Chronic (>12 weeks)Acute exacerbation of chronic . Chronic adult rhinosinusitis . Lasting > 12 weeksDiagnostically proven (major and minor clinical features)Wi

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Chronic Rhinosinusitis Definition clinical:

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    1. Chronic Rhinosinusitis Definition (clinical): Inflammatory response involving the following: mucous membranes, nasal cavity and paranasal sinuses. Fluid within the cavities and/or underlying bones. Symptomatic: nasal obstruction, congestion, discharge, purulent, postnasal drip, facial pressure and pain. Duration: 12 weeks Positive physical signs of nose and face. Ancillary studies: radiology.

    2. Rhinosinusitis: Classification Based on temporal nature: Acute (<4 weeks) Subacute (4-12 weeks) Recurrent acute (> 4 episodes per year) Chronic (>12 weeks) Acute exacerbation of chronic

    3. Chronic adult rhinosinusitis Lasting > 12 weeks Diagnostically proven (major and minor clinical features) With or without physical findings

    4. Chronic rhinosinusitis morphologic features: Inflammatory infiltrates Edema Glandular hyperplasia Thickened basement membrane Squamous metaplasia Eosinophils, may be present, can be numerous

    13. Proposed new histologic classification: Polypoid CRS Glandular CRS

    14. Proposed mechanism Polypoid CRS

    15. Proposed mechanism Glandular CRS

    16. Clinical applications Polyps: Topical steroids: 50-90% success Oral steroids, FESS, polypectomy: recurrence: 40-50%. Glandular: Try conservative approach Long-term topical steroids Macrolide ABx ?Pathogenic (possible infection) ?Reduce mucus hypersecretion

    17. Objectives: Increasing the communication between the clinicians and the pathologists Introducing new clinicopathological concepts Deciding upon clinical applications according to the morphologic findings Which relevant information should the clinicians provide to the pathologists? Should the pathologic report introduce a clinical entity alone (nondescriptive one)?

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