For many years, scientists and clinicians have been trying to understand the infinite variability within the term ‘rhinosinusitis’ using radiology, basic science, epidemiology and then using their insights to solve the riddle of management: how to explain why some patients will do well with minimal surgery, some will require more extensive and some will fail to respond to any treatment. The latest addition to this quest has been the definition of ‘central compartment disease’ – a (well-recognisable to any clinician who has dealt for many years with CRS patients) entity consisting of polypoid inflammatory changes affecting the middle and superior turbinate and septum as well as the ethmoid but with clear maxillary sinuses (the ‘halo sign’ as described earlier).
The authors assessed more than 300 patients and about 11% fell into this category. They found that these patients shared some unique characteristics – namely the high prevalence of allergy in the absence of asthma.
The authors attempt an interesting theory, namely that the central compartment serves as a filter for allergens, taking the “brunt” of them while protecting lower airway. It is certainly food for thought – watch this space!