Rhinosinusitis is caused by mucosal inflammation and local damage to mucociliary clearance mechanisms from viral infection or allergy. Increased mucus production and reduced clearance of secretions can lead to blockage of the sinus ostia, or the opening of the sinuses to the upper airway. This environment is ideal for bacterial growth and promotes a cycle of local inflammatory response and mucosal injury characterized

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by increased concentrations of interleukins, histamine, and tumor necrosis factor. '

Factors that contribute to bacterial invasion include nose blowing, reduced local im-


munity, viral virulence, and nasopharyngeal colonization with bacteria. ' Damage to the host defense system perpetuates bacterial overgrowth and persistence of infection.

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