Bone Remodeling and Disease in Chronic Rhinosinusitis

There is increasing interest in the bony framework of the paranasal sinuses as an important factor in recalcitrant CRS. This hypothesis is based mainly on the radiological changes, including areas of increased bone density and irregular thickening whose prevalence may be as high as 64 HU. We think that these bony changes are signs of bone inflammation or remodeling and markers of chronicity of disease, and they could at least partly explain why improved sinus ventilation and even removal of diseased sinus mucosa alone are sometimes insufficient for the treatment of CRS. We conducted this review to explore the role of paranasal bone tissue in CRS. The main aims were: to get better insight of the available data, to identify potential therapeutic implications, and to put forward suggestions for future research.