Chronic rhinosinusitis: the rationale for current treatments

Area of Science:

• Otolaryngology
• Immunology

Background:

• Chronic rhinosinusitis (CRS) is a complex inflammatory condition of the nasal and sinus mucosa.
• Current treatments include corticosteroids, antibiotics, and surgery, but evidence supporting their efficacy is often limited.
• CRS is considered a symptom complex rather than a distinct disease, hindering targeted treatment.

Purpose of the Study:

• To review current primary treatment modalities for chronic rhinosinusitis.
• To discuss the evidence base for corticosteroids, antibiotics, and surgery in CRS management.
• To highlight the need for better understanding of CRS phenotypes and endotypes for personalized medicine.

Main Methods:

• Review of existing literature on CRS treatments.
• Analysis of the evidence supporting corticosteroids, antibiotics, and surgical interventions.
• Discussion of emerging therapeutic strategies, including biologics.

Main Results:

• Corticosteroids demonstrate the strongest evidence of efficacy due to their broad anti-inflammatory properties.
• Antibiotics may benefit specific patient subpopulations, but effectiveness is limited by poorly defined CRS phenotypes.
• Surgery and biologics show potential for efficacy and cost-effectiveness in certain CRS phenotypes.

Conclusions:

• A deeper understanding of CRS inflammatory pathways is crucial for patient stratification.
• Identifying distinct patient groups will enable targeted clinical trials.
• Future research should focus on developing personalized therapeutic approaches for CRS.