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SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases.

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    Recalcitrant chronic rhinosinusitis (CRS) involves complex inflammation. Severe Chronic Upper Airway Disease (SCUAD) may help understand and treat persistent sino-nasal inflammation.

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    Area of Science:

    • Otolaryngology
    • Immunology
    • Respiratory Medicine

    Background:

    • Chronic rhinosinusitis (CRS) presents complex pathophysiological mechanisms.
    • Persistent inflammation in CRS often results from multifactorial etiology.
    • Interactions between upper and lower airway inflammation complicate CRS therapy.

    Purpose of the Study:

    • To review recent research on recalcitrant chronic rhinosinusitis (CRS).
    • To explore the relationship between CRS and Severe Chronic Upper Airway Disease (SCUAD).
    • To present a hypothesis on SCUAD immunopathology.

    Main Methods:

    • Literature review of Medline and Embase databases.
    • Search terms included 'chronic rhinosinusitis', 'chronic sinusitis', and 'Severe Chronic Upper Airway Disease'.
    • Limited to English-language articles.

    Main Results:

    • Complex pathophysiological mechanisms underlie persistent CRS inflammation.
    • Multifactorial etiology contributes to sino-nasal inflammation.
    • Neurogenic and systemic pathways linking upper and lower airway inflammation complicate treatment and symptom control.

    Conclusions:

    • Severe Chronic Upper Airway Disease (SCUAD) definition highlights patients with treatment-resistant inflammation.
    • SCUAD concept aids research into rhinitis and rhinosinusitis definition, diagnosis, and pathophysiology.
    • A hypothesis on SCUAD immunopathology is proposed.