Acute Exacerbations of Chronic Rhinosinusitis

Area of Science:

• Otolaryngology
• Immunology
• Microbiology

Background:

• Chronic rhinosinusitis (CRS) is a complex inflammatory condition of the upper airway.
• Acute exacerbations of chronic rhinosinusitis (AECRS) represent a significant clinical challenge.
• Previous definitions of AECRS lacked standardization, hindering research and clinical practice.

Purpose of the Study:

• To review recent advancements in understanding the evolving phenotype of AECRS.
• To focus on studies clarifying AECRS pathophysiology, patient characteristics, and disease burden.
• To highlight the importance of a formal definition for AECRS research and clinical translation.

Main Methods:

• Literature review of recent studies on AECRS.
• Analysis of evolving definitions and diagnostic criteria for AECRS.
• Examination of research on AECRS pathophysiology, risk factors, and treatment patterns.

Main Results:

• A recent regulatory definition for AECRS requires >3 days of worsened symptoms and treatment escalation.
• Patient-reported rescue medication frequency is unreliable for defining AECRS episodes.
• AECRS pathophysiology may involve sinonasal microbiome dysbiosis triggered by viral insults, leading to bacterial infection.
• CRS patients with asthma and/or allergic rhinitis are at increased risk for AECRS.
• Overprescription of antibiotics and corticosteroids for AECRS is common, increasing healthcare costs and risks.

Conclusions:

• A formal definition of AECRS is vital for translatable research and improved clinical outcomes.
• Understanding the interplay between CRS, asthma, and allergic rhinitis is key for managing AECRS.
• Mitigating the overuse of antibiotics and corticosteroids in AECRS management is essential to combat antibiotic resistance and adverse effects.