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Adult chronic rhinosinusitis
Claus Bachert1,2,3, Bradley Marple4, Rodney J Schlosser5
1Sun Yat-sen University, International Airway Research Center, First Affiliated Hospital, Guangzhou, China. bachert@mail.sysu.edu.cn.
Nature Reviews. Disease Primers
|October 30, 2020
Summary
Chronic rhinosinusitis (CRS), affecting over 10% of adults, presents distinct phenotypes with significant symptom overlap. Advances in understanding CRS pathophysiology and endotyping are driving personalized management strategies for improved patient outcomes.
Area of Science:
- Otolaryngology
- Immunology
- Pathophysiology
Background:
- Chronic rhinosinusitis (CRS) affects over 10% of adults in Europe and the USA.
- Two main phenotypes exist: CRS without nasal polyps and CRS with nasal polyps (CRSwNP).
- Both share a high disease burden and overlapping symptoms like facial pain and smell loss.
Purpose of the Study:
- To review recent advancements in understanding CRS pathophysiology.
- To highlight progress in diagnostic tools and management strategies for CRS.
- To discuss the impact of endotyping on personalized treatment approaches.
Main Methods:
- Review of current literature on CRS pathophysiology, including epithelial changes, immune pathways, and the role of eosinophils and Staphylococcus aureus.
- Analysis of recent developments in clinical manifestations, diagnostic methods (nasal endoscopy, imaging), and therapeutic interventions (pharmacotherapy, surgery, biologics).
- Discussion of endotyping's role in tailoring surgical approaches and identifying candidates for advanced therapies.
Main Results:
- Significant progress in elucidating CRS pathophysiology, involving epithelial-mesenchymal transition and immune system dysregulation.
- Evolution of diagnostic tools and management strategies, particularly for severe CRSwNP, driven by knowledge of key mediators.
- Introduction of endotyping enabling tailored surgical interventions and patient selection for biologics.
Conclusions:
- Understanding CRS pathophysiology has advanced significantly, impacting clinical practice.
- Endotyping represents a paradigm shift, facilitating personalized medicine in CRS management.
- Future directions include further refinement of tailored surgical approaches and the role of biologics in severe CRSwNP.
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