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Abstract It has been observed that CRS is becoming more resistant to common treatment. Moreover, the chronic nature makes the situation more difficult with regard to diagnosis and management. The latter often fails, and long-term antibiotic administration is often inadequate to eradicate disease that gradually affects patients‟ quality of life. Chronic rhinosinusitis (CRS) is a disease characterized by inflammation of the mucosa lining the paranasal sinuses; however, recent evidence also indicates the involvement of the sinus bones in the inflammatory process. In ongoing research to better characterize the pathogenesis of CRS with respect to reasons for failure, mucosa continues to receive the majority of attention, including factors such as the local immune response and biofilms. On the other hand, the role of osteitis, or inflammation involving bone, is much less extensively studied. “Osteitis” is characterized by varying degrees of increased osteoblastic-osteoclastic activity, resulting in disruption of organized lamellar bone and formation of immature woven bone. Expansion of the haversian canal system with entry of inflammatory infiltrate in an increased vascular network has been demonstrated, wherein osteitis may act as a potential pathway for spread of mucosal disease. The current study assess the presence of osteitis in ethmoid bone and tissue eosinophilia in nasal mucosa of patients with chronic rhinosinusitis, with nasal polyps, without nasal polyps and allergic fungal sinusitis to find out if there is correlation between etmoid bone osteitis, tissue eosinophilia and severity of chronic rhinosinusitis. Patients were evaluated clinically by SNOT 22 score, radiologically by Lund-Mackay score and biopsies were taken from ethmoid bone and mucosa and assessed histopathologically. As regard results of specimen under LM; seventy five specimen were examined from three study groups that show osteitis in 92% with more severe affection in AFS patients, there was variable degree of mucosal affection and tissue esinophilia and there was strong correlation between mucosal and bony grading.The current study show correlation between SNOT 22 score clinically and Lund-Mackay score radiologically. There is strong correlation between osteitis and tissue eosinophilia Regarding 10 control patients, specimen show 30% osteitis and remaning normal bone. Definition of chronic rhinosinusitis shoud be modified from only sinus mucosal affection to include bony osteitis. Further studies are needed to search for etiology of osteitis in CRS patients, modification of FEES for eradication of osteitic bones and possible medical treatments for osteitis to prevent recurrent rhinosinusitis. |