Highlights in the advances of chronic rhinosinusitis

Abstract

Chronic rhinosinusitis (CRS) is a protracted inflammatory condition with global societal and financial burden. [1][2][3] Its prevalence is estimated to be 10-28% based on self-reported symptoms alone, 4,5 and about 4-9% when endoscopy 6 or imaging is applied. 7,8 Real world data suggest that nearly half of CRS patients have uncontrolled disease based on visual analogue scale for rhinosinusitis. 9 This subgroup has significant disease burden as these patients require longterm follow-up, medication and often repeat sinus surgeries. 10 Traditionally, CRS is classified based on the presence or absence of nasal polyps. It is evident that this classification based on a visual trait is probably an overly simplistic representation of a heterogenous condition with a spectrum of clinical presentations and severity. Hence in recent years, there is increasing interest in uncovering the inflammatory mechanisms, or endotypes, of CRS. With the advent of novel treatment options, including biologicals, the ability to accurately define endotypes and predict response to specific treatments via biomarkers is important in order to provide individualised patient care. 11 Research in CRS is a continually evolving field. The objective of this review is to update readers on the recent, important developments in the field of CRS in adults. This includes the changes in the latest edition of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2020), novel biomarkers, biologicals in the treatment of CRSwNP and the implications of the COVID-19 on the

Chronic Rhinosinusitis and COVID-19

“…115 However, there are no formal studies investigating the influence of type 2 biologics on COVID-19 risk and severity in patients with CRSwNP. Although the European Academy of Allergy and Clinical Immunology position paper on managing CRS during the COVID-19 pandemic recommends that biologics be stopped until patients with COVID-19 symptoms complete recovery, 116 a riskebenefit assessment must be carefully conducted for CRSwNP patients treated with biologics.…”

Elevated ALCAM Expression Associated with Endotypes and Postoperative Recurrence in Chronic Rhinosinusitis with Nasal Polyps

“…Chronic rhinosinusitis (CRS) is a highly prevalent disease characterized by chronic inflammation of the nasal cavity and sinuses, and it has impacted approximately 10% of the Chinese population. 1 , 2 CRS is a multifactorial disease and is frequently grouped into two phenotypes based on the presence or absence of nasal polyps: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). 3 , 4 Accordingly, CRSwNP is a highly heterogeneous disorder with massive infiltration of inflammatory cells and mediators in the tissue.…”

An Integrated Analysis of Inflammatory Endotypes and Clinical Characteristics in Chronic Rhinosinusitis with Nasal Polyps

“…Currently, there is evidence that the T2 endotype is associated with nasal polyps formation and asthma. 9 Pronounced eosinophilia of nasal polyps is observed frequently in T2 inflammation. 10 The correlations between the T2 endotype and other clinical phenotypes are still uncertain.…”