Clinical and Endoscopic Findings
Many patients with chronic rhinosinusitis present nasal obstruction as the primary complaint. Other symptoms include nasal discharge, postnasal drip, facial pain, dysosmia, chronic cough, and headache. Headache is usually dull and radiating to the top of the calvarium or bitemporal for sphenoid or posterior ethmoid disease. Pain at the glabella, inner can-thus, or between the eyes suggests anterior ethmoid or frontal rhinosinusitis. Pain over the cheeks most frequently suggests maxillary rhinosinusitis.
Patients with sinonasal polyposis complain of symptoms similar to those reported by patients with chronic rhinosinusitis, as the two diseases frequently coexist. Conversely, when an isolated polyp arises in a nasal fossa, unilateral signs and symptoms are generally reported. Among sinonasal inflammatory diseases, sinonasal polyposis is the one most frequently associated with bronchial hyperresponsiveness, with a percentage of up to 50% (HoLmstRom et al. 2002). This association is more evident in patients with diffuse eosinophilic sinonasal polyposis.
In chronic rhinosinusitis, endoscopy shows an edematous and inflamed mucosa with a thick mucous or mucopurulent secretion outflowing from the os-tiomeatal complex and/or the sphenoethmoid recess. Anatomical anomalies or small polyps obstructing the middle meatus may also be observed (Fig. 6.7).
In the presence of a diffuse sinonasal polyposis, endoscopy displays multiple soft, lobular and mobile formations, variable in size, with a smooth and shiny surface, bluish-gray or pink in color, more frequently arising in the middle meatus (Fig. 6.8). As a consequence of sinonasal ostia obstruction, also in sinonasal polyposis endoscopic signs of acute rhino-sinusitis can be observed. Antrochoanal polyp, which is considered a separated entity, is a lonely neoformation originating from the mucosa of the maxillary sinus which bulges, due to its considerable size, into the nasopharynx through the choana.
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