Sinusitis is a heterogeneous group of disorders resulting in the inflammation of the sinuses. There are many potential causes. The simplest thinking is a combination of narrow sinus outflow tracts compromised by mucosal swelling (mucosa line the sinuses) from allergy or infection or other non allergic irritation resulting in a back up of mucous in the sinuses and like stagnant water this mucous then gets secondarily infected. Although this holds true for some people and may explain many acute episodes we now realise that it is far more complex and many of the potential causes relate to conditions which cause chronic inflammation of the mucosa such as biofilms (communities of bacteria and fungi which form on damaged areas of the mucosa and are resistant to regular treatment), osteititis (inflammation of the underlying bone), superantigens (bacteria like staph aureus which can trigger a much larger than normal inflammatory response), allergy or over reaction to fungi, or inherent disorders of the bodies innate immune system.
Appreciating the complexity and various potential causes allows us to treat patients differently. The same treatment won't be effective for every patient. It also explains why so many patients don't respond to simple antibiotics or can't be fixed by surgery alone.
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