Latest advances in chronic rhinosinusitis with nasal polyps endotyping and biomarkers, and their significance for daily practice

Abstract

The term chronic rhinosinusitis (CRS) comprises of an assortment of diseases that share a common feature: inflammation of the sinonasal mucosa. The phenotype classification of CRS, based on the presence of polyps, has failed to offer a curative treatment for the disease, particularly in refractory cases. Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging entity. Researchers have made efforts trying to characterize subtypes of the disease according to the endotypes, which are delineated by different immunological pathways, using biomarkers. Even if the inflammatory processes controlling CRSwNP are not fully understood, data suggested that the disease associated with a type 2 inflammatory mechanisms can be also linked to the type 1 or type 3 pathomechanism, being highly heterogeneous. Biomarkers for CRSwNP are proposed, such as: eosinophil count, cytokines, metalloproteinases, bitter and sweet taste receptors, and the nasal microbiome. For endotyping to be clinically applicable and simply determined, biomarkers referring to the intrinsic biomolecular mechanism still need to be found. Precision medicine is becoming the new standard of care, but innovative therapies such as biologics may be rather challenging for the clinicians in their daily practice. This new approach to CRSwNP implies patient selection and a simple algorithm for deciding the right treatment, easy to implement and adjust. Our review points out the ongoing new research on the pathophysiology of CRSwNP, biomarkers and treatment opportunities. It allows clinicians to keep abreast of current evidence-based knowledge and to individualize the management of CRSwNP, especially in refractory cases.

Current approach of juvenile nasopharyngeal angiofibroma: a case series

“…Occasionally, the symptomatology is similar to that of an inflammatory rhinopharyngeal condition; in other cases, it mimics a tumoral nasal congestion, entailing a thorough clinical examination and urgent diagnostic imaging [22][23][24].…”

Impacts of sinonasal polyposis on ventilatory pulmonary function pre and post functional endoscopic sinus surgery

“…CRSwNP has a negative impact on patients' quality of life, not only due to the discomfort of specific symptoms (chronic rhinorrhea, nasal obstruction, facial pressure and hyposmia), but also due to central dysfunction manifested as fatigue and loss of sleep, which may further cause cognitive impairment or depression [10] . Asthma and allergic rhinitis are presenting with numerous phenotypes and are considered the most frequent chronic inflammation of both upper and lower airways, that's why we focused our attention on it [11].…”

Managing Chronic Rhinosinusitis with Nasal Polyps in the Elderly: Challenges and Solutions

“… 37 Eosinophilic infiltrates driven by type 2 response are a key component of most descriptions. 14 , 40 , 41 There are two endotypes frequently mentioned in the literature – eosinophilic (also referred to as type 2 mediated) nasal polyps (E-NP) and non-eosinophilic (also termed neutrophilic or non-type 2 mediated) nasal polyps (NE-NP). A breakdown described by Grayson et al is included below in Figure 3 .…”