Characterizing endotypes in chronic rhinosinusitis: emerging research and clinical applications

The purpose of this study is to describe why this review is timely and relevant. Endotyping, the organization of rhinologic inflammation around immunologic precepts, has evolved from a research subject to a clinically relevant tool with the advent of targeted biologics in chronic rhinosinusitis (CRS). This review highlights recent progress but also the challenges to implementing endotype-based care into routine clinical practice.

Describe the main themes in the literature covered by the article. Recent literature demonstrates organization of patients around multiple endotypes, most prominently Type 2, Type 1/3, pauci-inflammation, and mixed inflammatory profiles. Three principal approaches to endotyping have been widely utilized: cellular (histology-based) analysis, single-biomarker, and multibiomarkers assays. Emerging machine-learning models further enhance data-driven multibiomarkers classification. Importantly, developed endotypes demonstrate correlates with key clinical features, postoperative outcomes, and responsiveness to sinus surgery and biologic therapy.

Describe the implications of the findings for clinical practice or research. Increase use of precision biologics necessitates developing well validated endotypes to better select therapy for patients. Three major approaches - histology-based, single-biomarker, and multibiomarker strategies - are commonly employed, each with distinct advantages and limitations. Moving forward, standardization of methods, development of cost-effective testing, and rigorous clinical validation remain essential steps.