Osteitis and paranasal sinus inflammation: What we know and what we do not

PURPOSE OF REVIEW: There is increased recognition of the high prevalence of osteitic changes affecting the bony framework of the sinuses in patients with chronic rhinosinusitis (CRS) with or without nasal polyps. However, their grading, clinical significance, and management remain controversial. RECENT FINDINGS: A number of studies have confirmed that there is a clear correlation between radiological severity and extent of CRS, as measured with Lund-Mackay grading system, and osteitis. However, there is little or no correlation between clinical severity and osteitis, with no evidence of worse quality of life or more nasal symptoms or headache in such patients. The number of previous surgeries appears to be closely correlated with the extent of sinusitis, although it is not clear whether that is a direct or a secondary association. Global Osteitis Grading Scale is a novel validated composite grading system -measuring the extent and severity of osteitis. SUMMARY: Osteitis is more often present in patients with extended radiological disease and in patients undergoing revision surgery. More studies are necessary regarding its management, clinical implications, and natural course.