Diagnostic Criteria for a Curable Form of Chronic Rhinosinusitis: The Mucous Recirculation Syndrome


      In clinical practice, nonallergic rhinosinusitis (rhinopathy) is a common diagnosis of exclusion. The mucous recirculation syndrome is one incompletely defined condition that masquerades as nonallergic rhinopathy. Mucous recirculation syndrome, a curable condition, should be differentiated from nonallergic rhinopathy. The underdiagnosis of this condition is due in part to a lack of diagnostic criteria. In this article, we review the medical literature to better characterize mucous recirculation syndrome and to establish diagnostic criteria for it.


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        • Kaliner M.A.
        • Baraniuk J.N.
        • Benninger M.
        • et al.
        Consensus definition of nonallergic rhinopathy (NAR), previously referred to as vasomotor rhinitis (VMR), nonallergic rhinitis, and/or idiopathic rhinitis.
        World Allergy Organ J. 2009; 2: 119-120
        • Settipane R.A.
        Other causes of rhinitis: mixed rhinitis, rhinitis medicamentosa, hormonal rhinitis, rhinitis of elderly, and gustatory rhinitis.
        Immunol Allergy Clin North Am. 2011; 31: 457-467
        • Kaliner M.A.
        Nonallergic rhinopathy (formerly known as vasomotor rhinitis).
        Immunol Allergy Clin North Am. 2011; 31: 441-455
        • Reed J.S.
        • deShazo R.D.
        • Houle T.T.
        • Stringer S.
        • Wright L.B.
        • Moak S.J.
        Clinical features of sarcoid rhinosinusitis.
        Am J Med. 2010; 123: 856-862
        • Ly T.
        • deShazo R.D.
        • Oliver J.
        • Stringer S.
        • Daley W.
        • Stodard C.
        Diagnostic criteria for atrophic rhinosinusitis.
        Am J Med. 2009; 122: 747-753
        • deShazo R.D.
        • Swain R.E.
        Diagnostic criteria for allergic fungal sinusitis.
        J Allergy Clin Immunol. 1995; 96: 24-35
        • Messerklinger W.
        Endoscopy of the Nose.
        Urban Schwartzenberg, Baltimore, MD1978
        • Yanagisawa E.
        • Weaver E.M.
        Endoscopic view of recirculation phenomena of sphenoid sinus drainage.
        Ear Nose Throat J. 1996; 75: 68-70
        • Matthews B.L.
        • Burke A.J.C.
        Recirculation of mucus via accessory ostia causing chronic maxillary sinus disease.
        Otolaryngol Head Neck Surg. 1997; 117: 422-423
        • Kane K.J.
        Recirculation of mucus as a cause of persistent sinusitis.
        Am J Rhinol. 1997; 11: 361-369
        • Chung S.K.
        • Cho D.Y.
        • Dhong H.J.
        Computed tomogram findings of mucous recirculation between the natural and accessory ostia of the maxillary sinus.
        Am J Rhinol. 2002; 16: 265-268
        • Coleman J.R.
        • Duncavage J.A.
        Extended middle meatal antrostomy: the treatment of circular flow.
        Laryngoscope. 1996; 106: 1214-1217
        • Yanagisawa E.
        • Yanagisawa K.
        Endoscopic view of recirculation phenomenon of the maxillary sinus.
        Ear Nose Throat J. 1997; 76: 196-198
        • Chung S.K.
        • Dhong H.J.
        • Na D.G.
        Mucus circulation between accessory ostium and natural ostium of maxillary sinus.
        J Laryngol Otol. 1999; 113: 865-867
        • Gutman M.
        • Houser S.
        Iatrogenic maxillary sinus recirculation and beyond.
        Ear Nose Throat J. 2003; 82: 61-63
        • Kane K.J.
        Persistent sinusitis from recirculating mucus after inferior turbinectomy.
        Int Congr Ser. 2003; 1240: 463-467
        • Stammberger H.R.
        Functional Endoscopic Sinus Surgery. The Messerklinger Technique.
        B.C. Decker, Philadelphia1991
        • Settipane R.A.
        • Charnock D.R.
        Epidemiology of rhinitis: allergic and nonallergic.
        in: Baraniuk J.N. Shusterman D. Nonallergic Rhinitis. Informa, New York2007: 23Y34
        • Mladina R.
        • Vukovic K.
        • Poje G.
        The two holes syndrome.
        Am J Rhinol Allergy. 2009; 23: 602-604
        • Mladina R.
        • Skitarelić N.
        • Casale M.
        Two holes syndrome (THS) is present in more than half of the postnasal drip patients?.
        Acta Otolaryngol. 2010; 130: 1274-1277
        • Webb D.R.
        • Meltzer E.O.
        • Finn A.F.
        • et al.
        Intranasal fluticasone is effective for perennial nonallergic rhinitis with or without eosinophilia.
        Ann Allergy Asthma Immunol. 2002; 88: 385-390
        • Banov C.H.
        • Lieberman P.
        • Vasomotor Rhinitis Study Groups
        Efficacy of azelastine nasal spray in the treatment of vasomotor (perennial nonallergic) rhinitis.
        Ann Allergy Asthma Immunol. 2001; 86: 28-35