What are the key diagnostic criteria for chronic rhinosinusitis in adults?

Key diagnostic criteria for chronic rhinosinusitis (CRS) in adults include the presence of symptoms persisting for 12 weeks or longer, involving nasal blockage, nasal discharge (anterior/posterior nasal drip), facial pain or pressure, and/or reduction or loss of smell. These symptoms should be supported by objective evidence of sinonasal inflammation, which can be confirmed by nasal endoscopy showing mucosal changes or polyps, or by CT imaging demonstrating mucosal changes within the sinuses.

Specifically, the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020), which informs UK guidelines, defines CRS by the persistence of two or more symptoms for at least 12 weeks, one of which should be nasal blockage/obstruction/congestion or nasal discharge, with or without facial pain/pressure and/or reduction or loss of smell, plus objective evidence of inflammation on endoscopy or CT scan ¹.

Additional diagnostic considerations include identifying and addressing contributing factors such as asthma, allergic rhinitis, smoking, and immune dysfunction, which predispose to CRS ¹. Allergy testing and immune function tests may be helpful to differentiate CRS from other causes of nasal symptoms and to identify underlying comorbidities ¹.

From the literature, Rosenfeld et al. (2015) emphasize that diagnosis requires both clinical symptoms lasting more than 12 weeks and objective confirmation of inflammation via endoscopy or imaging, aligning with guideline criteria. Patel et al. (2014) describe a subtype of CRS related to mucous recirculation syndrome, highlighting the importance of detailed clinical and endoscopic assessment to identify specific treatable forms. Sedaghat et al. (2022) reinforce that CRS diagnosis is symptom-based but must be corroborated by objective findings to avoid misclassification.

In summary, the key diagnostic criteria for adult chronic rhinosinusitis are: persistent symptoms for ≥12 weeks including nasal blockage or discharge, supported by endoscopic or radiological evidence of sinonasal mucosal inflammation or polyps, with consideration of associated conditions that may influence diagnosis and management ¹; (Rosenfeld et al., 2015); (Patel et al., 2014); (Sedaghat et al., 2022).