[Practice-oriented overview - current state of rhinosinusitis in adults based on the latest consensus papers and...

Over the past two decades, a paradigm shift has occurred in the understanding and management of rhinosinusitis, leading to new therapeutic options, necessitating a revised diagnostic and therapeutic approach. Nevertheless, avoidable errors are still frequently made in clinical practice. Rhinosinusitis ranks among the most prevalent upper respiratory tract conditions globally and is associated with a significant individual and socioeconomic burden. To prevent overdiagnosis and promote effective treatment, it is essential to understand the current classification, pathophysiology, and etiology of both acute (ARS) and chronic rhinosinusitis (CRS). The pathogenesis of rhinosinusitis extends beyond structural or infectious-inflammatory causes, with specific inflammatory mechanisms at the molecular level playing a pivotal role. The etiology of ARS is primarily viral, while secondary bacterial involvement is relatively rare. Diagnosis is based on clinical findings, and in most cases, the condition is self-limiting, requiring only symptomatic management. In contrast, CRS often does not result from ARS but arises due to impaired mucosal barrier function or microbial dysbiosis, underpinned by dysregulation of the innate and adaptive immune systems (endotypes). These mechanisms lead to a heterogeneous clinical presentation (phenotypes), which must be considered for accurate diagnosis and appropriate treatment. This article addresses the broad field of rhinosinusitis from the perspective of clinical practice in German-speaking Europe.