Pathophysiology of inflammation in the surgically failed sinus cavity

Chronic rhinosinusitis with or without polyps is an inflammatory disease. Treatment should always consist of a sandwich of optimal medical treatment, if necessary followed by surgery and than always followed by a (sometimes extensive) period of medical treatment. • Both extrinsic and intrinsic patient factors may be associated with an unfavourable outcome after endoscopic sinus surgery. • A careful assessment of these factors may serve as a helpful prognostic indicator of the outcome of endoscopic sinus surgery. • Optimising the management of underlying systemic disease is vital in order to achieve a satisfactory outcome, especially in revision surgery.