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Type: Journal article
Title: (AS)Mucosal remodeling and reversibility in chronic rhinosinusitis
Author: Bassiouni, A.
Chen, P.
Wormald, P.
Citation: Current Opinion in Allergy and Clinical Immunology, 2013; 13(1):4-12
Publisher: Lippincott Williams & Wilkins
Issue Date: 2013
ISSN: 1528-4050
Statement of
Ahmed Bassiouni, Philip G. Chen and Peter-John Wormald
Abstract: <h4>Purpose of review</h4>Evidence suggests that some structural changes caused by mucosal remodeling may be primarily irreversible, which theoretically challenges the current management model of chronic rhinosinusitis (CRS). The relationship between inflammation and remodeling in the mucosa remains complex, yet better understanding of involved pathways holds potential clinical implications. This article reviews the controversies as well as current applications from the literature.<h4>Recent findings</h4>First, the relationship between inflammation and remodeling is a complex one involving multiple pathways, with evidence suggesting that remodeling is not a simple fibrotic end-stage process secondary to long-standing inflammation. Second, anti-inflammatory approaches alone are probably not successful in reversing changes such as collagen deposition, indicating that early treatment might be crucial for preventing disease progression. Third, a dysfunctional sinus remains a pure clinical/surgical phenomenon with lack of histological characterization. Fourth, maximal/extensive surgical techniques are advocated for patients with severe disease or dysfunctional sinuses.<h4>Summary</h4>Reversibility of remodeling holds implications for the management of CRS. Although clinical applications (both medical and surgical) exist, further research is required for solidifying current evidence as well as exploring new avenues for therapy.
Keywords: Chronic rhinosinusitis
dysfunctional sinus
endoscopic sinus surgery
irreversible mucosal disease
mucosal remodeling.
Rights: © 2013 Lippincott Williams & Wilkins
DOI: 10.1097/ACI.0b013e32835ad09e
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