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CRS, or chronic rhinosinusitis, is sinusitis - an inflammation of the sinuses - which lasts for more than ten to twelve weeks. CRS symptoms may include the following:

  • Difficulty breathing as a result of nasal airway obstruction
  • Nasal congestion, or stuffiness
  • Nasal discharge, or runny nose
  • Pain in the head and face
  • Decreased sense of smell

Acute rhinosinusitis, or acute sinusitis, is different from CRS because it is caused by a bacterial or viral infection and because symptoms occur for a shorter time period of less than four weeks.

37 million adults and 7 million children in the U.S. are affected by CRS. While anyone can have CRS, it more likely to occur in people with other respiratory conditions like asthma or allergies. Individuals with these conditions or those who think they may have CRS should speak with their physician to obtain more information about CRS and to discuss diagnosis and treatment options if necessary.

The cause of CRS had not been fully understood until 1999 when Dr. Sherris, lead researcher from the Mayo Clinic and his team, discovered that fungus plays a major role in CRS. Like pollen and dust mites, fungus is present in the air. Because of this, it is normally found in the nasal passages of healthy people as well as those with CRS, though for the patient with CRS the body has an unusual immune response to the fungus that results in the symptoms of CRS.

For CRS patients, the fungus is identified as foreign by cells called lymphocytes which then produce chemical-like substances that start an immune response. These substances, known as cytokines, signal other cells to start a defense against the fungus. IL-13 and IL-5 are the cytokines involved in this process and they bring in and activate other cells, known as eosinophils, which are also part of the body’s normal defense system. The eosinophils locate the fungus in the mucus where they break apart, or degranulate, and release a toxic substance which kills the fungus. However, the nasal tissue is also injured by this substance and this results in the symptoms of CRS.

Nasal polyps and other changes in the structure of the nasal passages can result over time due to this damage. Furthermore, the damaged tissue can be susceptible to infection by the bacteria which cause acute sinusitis.


To learn more about CRS watch the Chronic Rhinosinusitis DVD which is broken out into 7 chapters, or the CRS Update video. Or, contact the Clinic of Plastic Surgery today for more information.

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David A. Sherris, MD

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