The significance of osteitis in rhinosinusitis.

Rhinosinusitis is a disease of multifactorial aetiology. As a profession our insight into this pathological process has progressed enormously over the last few decades. The contribution from environmental, host immunity, microbiology and anatomical factors is well recognised, if not completely understood. The involvement of underlying bone in rhinosinusitis was first recognised experimentally in animals and has subsequently been highlighted as a potentially significant finding in humans with CRS. In this review, the role of bone in chronic rhinosinusitis and the evidence behind that role are discussed. Both histological and radiological findings are presented and the subsequent potential clinical impact and relevance of osteitis in rhinosinusitis patients. Future pathways for research to add to the current knowledge of the impact of bony involvement are also discussed.