Table 7.

Mechanistic classification of the differential diagnosis for rhinosinusitis

Inflammatory leukocytes			No inflammatory leukocytes
Eosinophilia	Neutrophilia	Mixed or poorly defined	Epithelial dysplasia	Neural involvement				Hormonal	Anatomic and structural changes
				Trigeminal nociceptive dysfunction of “visceral sensations”	Parasympathetic dysfunction	Sympathetic: Vascoconstrictor dysfunction	Olfactory dysfunction
•Allergic, IgE/mast cell- mediated rhinitis •Nonallergic rhinitis with eosinophilia syndrome (NARES) •Chronic eosinophilia sinus syndrome (CESS) •Nasal polyposis and polypoid rhinosinusitis •Aspirin-NSAID sensitivity •Eosinophilic granuloma •Allergic fungal rhinosinusitis and other syndromes of eosinophilic-fungal disease	•Acute bacterial rhinosinusitis •Bacterial exacerbations of chronic sinusitis •Ciliary dysfunction-Kartagener syndrome •Immune dysfunction-IgA deficiency/common variable hypogammaglobulinemia •Dentogenic sinusitis •Foreign body	•Viral infections •Vasculitis-Wegener granulomatosis/midline granuloma •Basophilic nonallergic rhinitis •Glandular hyperplastic chronic rhinosinusitis	•Atrophic rhinitis •Oxena •Sjogren syndrome •Acute oxidant-particulate exposure (eg, smoke, occupational agents) •Transient epithelial denudations with neutrophilia and appropriate repair •Epithelial metaplasia leading to permanent keratinization	•Aδ first pain-VRL-1/>50°C •Aδ Cold (L)-menthol receptor: regulation of airflow (dyspnea, work of breathing) •Type C-second pain (parasthesia)/VR1+/ neuropeptides •Type C-second pain (parasthesia)/ VR1+/IB-4 lectin+ •Type C itch-histamine/H-1 receptors/flare (axon response release of CGRP vasodilator) •Mechanical stretch (assess degree of sinusoidal swelling?)/ (mucosal contact?) •Irritant rhinitis of chronic fatigue syndrome (CFS), multiple chemical sensitivity and chronic multisymptom illness (CMI)	•Cholinergic rhinitis •“Gustatory rhinitis”/ “skier’s nose”	•Rhinitis medicamentosa •Cocaine abuse •Antihypertensive drugs-β-blockers/ACE inhibitors	•Nasal toxicants associated with olfactory metaplasia •Parkinson disease •Alzheimer disease •Head trauma •Other intracranial pathology extending to nasal and sinus cavities	•Hypothyroid •Pregnancy	•Nasal septal deviation or spurs •Concha bullosa •Benign and malignant tumors

NSAID, Nonsteroidal anti-inflammatory drug; VRL, vanilloid receptor-like; VR1, vanilloid receptor subtype 1, recently renamed transient receptor potential vanilloid receptor 1 (TRPV1); ACE, angiotensin-converting enzyme.