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Abstract

Recalcitrant sinusitis is persistent sinusitis inspite of proper medical and surgical treatment. According to this definition it does not include improper medical treatment and/or bad surgical techniques. Many factors may contribute to persistence of sinusitis including host factors, environmental factors, and microbiologic factors. Current research has shown increasing role of Staph aureus in developing recalcitrant forms of sinusitis through the formation of biofilms, the production of super antigens, and synergy with fungi. Intracellular Staph aureus is also an important factor. Several immunologic factors may also predispose to recalcitrant sinusitis. Environmental factors, including active and passive smoking, are usually ignored by the patients and the physicians as well in spite of their proved deleterious effects on the nasal factors. All these factors will be briefly mentioned and discussed.

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