Nasal cavity
Inflammatory / infectious lesions
Chronic sinusitis (rhinitis)

Author: Jihong Sun, M.D. (see Authors page)
Editor: Margie Brandwein-Gensler, M.D.

Revised: 14 April 2016, last major update March 2015

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Chronic rhinitis nasal cavity
Definition / General
  • Chronic inflammation of the nasal cavity (rhinitis) or the paranasal sinuses (sinusitis), symptoms lasting more than 6 weeks
  • Sequel to acute rhinitis (symptoms lasting 6 weeks or less), with development of secondary bacterial infection
  • Associated with deviated septum or nasal polyps; also ulceration and infection extending into sinuses
Essential Features
  • Thickened, hyalinized basement membrane (minimal criteria) directly beneath respiratory epithelium and around seromucinous glandular tubuli
Terminology
  • Rhinosinusitis, sinusitis
Epidemiology
  • Most common health problem in the United States
Sites
  • Unilateral or bilateral, nasal cavity or paranasal sinus
Pathophysiology
  • Associated with deviated septum or nasal polyps
  • Ostial obstruction in osteomeatal compex causes anaerobic overgrowth
Etiology
  • Allergy, vasomotor (constricted or dilated vessels), infection, diabetes mellitus, cystic fibrosis, Kartagener syndrome, aspirin intolerance, Churg Strauss disease, nickel exposure
Clinical Features
  • Facial pain, pressure, congestion or fullness; nasal obstruction, blockage, discharge or purulence
Radiology Images
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Left maxillary sinus that was almost totally opacified

Treatment
  • Aeration or drainage, ensuring ostial patency
Clinical Images
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Pale turbinates and dry
secretions in smoker

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Uncinate process is enlarged
and anteriorly bent

Micro Description
  • Thickened basement membrane (minimal criteria) directly beneath respiratory mucosa and around seromucinous glandular tubuli
  • Increased lymphoplasmacytic infiltrate
  • Goblet cell hyperplasia and papillary hyperplasia
  • Squamous metaplasia can be seen and is associated with cigarette exposure Nasal polyp
Micro Images
Images hosted on PathOut server, courtesy of Dr. Margie Brandwein-Gensler, M.D.:
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Sinonasal polyps

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Chronic rhinosinusitis

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A. Papillary hyperplasia
B. Thickened basement membrane



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Chronic Sinusitis

Differential Diagnosis