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Diseases of the Sinuses pp 45–56Cite as

Physiology and Host Immune Responses of the Nose and Sinuses

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Abstract

The nose and converging structures have several critical functions that are often trivialized until symptoms persist and interfere with the patient’s daily activities. The nose is the body’s heating, ventilation, and air conditioning (HVAC) system, as it humidifies, filters, and conditions air. These functions protect the lungs from an influx of aeroallergens, air particulates, and other potential deleterious air pollutants. The nasopharynx is colonized with normal flora that acts as commensal organisms to prevent colonization of the host with more pathogenic organisms, thereby preventing disease. There are several natural protective mechanisms in the nose that are part of the innate immune response. Because the nasal epithelium provides a weak protective barrier, innate immunity plays a very important role to prevent infection and other pathologic inflammatory responses. The humoral adaptive immune response plays an important role in combating infection as well as eliciting specific IgE-mediated responses in susceptible individuals. When one or more of these processes break down, chronic rhinosinusitis (CRS), characterized by persistent inflammation of the mucosa in the nose and paranasal sinuses, can result. Most cases of chronic rhinosinusitis are idiopathic. Proposed mechanisms for CRS included obstruction of the osteomeatal complexes, impaired mucociliary transport, atopy, microbial resistance, and biofilm formation. Correct diagnosis and appropriate treatment of patients with allergic, nonallergic, or mixed rhinitis to prevent unchecked nasal inflammation will often prevent or ameliorate the progression to chronic rhinosinusitis. Future research investigating the pathogenesis and mechanism(s) of CRS will provide better opportunities for developing novel therapies to improve our management of this common clinical condition.

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Authors and Affiliations

  1. Division of Immunology, Department of Internal Medicine, Allergy Section, University of Cincinnati, 3255 Eden Ave ML#563 Suite 350, Cincinnati, OH, USA

    Jonathan A. Bernstein MD

  2. Division of Immunology, Allergy, and Rheumatology, Cincinnati VA Medical Center, University of Cincinnati, 3255 Eden Ave., ML#563, Cincinnati, OH, USA

    Andrew M. Smith MD, MS

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  1. Jonathan A. Bernstein MD
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Correspondence to Jonathan A. Bernstein MD .

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Editors and Affiliations

  1. Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University, Wilmington, Delaware, USA

    Christopher C. Chang

  2. Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California, USA

    Gary A. Incaudo

  3. The Jack and Donald Chia Distinguished Professor of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California, USA

    M. Eric Gershwin

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Bernstein, J.A., Smith, A.M. (2014). Physiology and Host Immune Responses of the Nose and Sinuses. In: Chang, C., Incaudo, G., Gershwin, M. (eds) Diseases of the Sinuses. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0265-1_2

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