Chronic rhinosinusitis
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Chronic Rhinosinusitis: An Overview
Definition and Epidemiology of Chronic Rhinosinusitis
Chronic rhinosinusitis (CRS) is a prevalent condition characterized by prolonged inflammation of the nasal and sinus linings, lasting at least 12 weeks9. Affecting over 10% of adults in Europe and the USA, CRS significantly impacts patients' quality of life due to symptoms such as nasal blockage, rhinorrhea, facial pain, and loss of smell1 5. The disease can be classified into two main phenotypes: CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP)1.
Pathophysiology and Endotypes
CRS is a heterogeneous disorder with complex pathophysiological mechanisms. Recent research has identified distinct immune response patterns, leading to the classification of CRS into different endotypes based on type 1, type 2, and type 3 immune responses3. Type 2 immune responses, characterized by the involvement of ILC2s, Tc2, and TH2 cells, are the most studied and are associated with CRSwNP. These endotypes help in understanding the disease's pathogenesis and tailoring specific treatments3.
Role of Environmental Factors
Environmental pollutants and occupational exposures have been implicated in the onset and severity of CRS. Pollutants can exacerbate the inflammatory processes underlying CRS, contributing to disease persistence and severity2 7. This highlights the importance of considering environmental factors in the management and prevention of CRS.
Microbiota and CRS
The sinonasal microbiota plays a crucial role in CRS. Studies have shown that CRS patients exhibit a dysbiotic bacterial community with reduced diversity and increased abundance of certain bacteria like Corynebacterium4. Healthy sinonasal microbiota, characterized by the presence of genera such as Burkholderia and Propionibacterium, is essential for maintaining sinonasal health4.
Diagnostic and Management Strategies
Diagnosis of CRS involves clinical evaluation, nasal endoscopy, and imaging techniques. Management strategies have evolved significantly, incorporating pharmacotherapy, surgery, and biologics. The introduction of endotyping has led to more tailored surgical approaches and the identification of patients who may benefit from biologics1.
Pharmacotherapy and Biologics
Pharmacotherapy remains a cornerstone in CRS management, with intranasal steroids being commonly used. Biologics, such as dupilumab, mepolizumab, and omalizumab, have shown promise in treating severe CRSwNP by targeting specific inflammatory pathways5. Dupilumab, for instance, has been shown to improve disease-specific quality of life and reduce the need for surgery5.
Surgical Interventions
Surgical interventions are considered for patients who do not respond to medical therapy. Advances in surgical techniques, guided by endotyping, have improved outcomes for patients with severe CRSwNP1.
Osteitis and CRS
Osteitis, characterized by periosteal thickening and new bone formation, is often associated with CRS. Its role in the pathogenesis of CRS is still under investigation, but it is believed to contribute to the chronicity and severity of the disease6.
Conclusion
Chronic rhinosinusitis is a complex and multifactorial disease with significant implications for patients' quality of life. Advances in understanding its pathophysiology, the role of environmental factors, and the sinonasal microbiota have led to more targeted and effective management strategies. Continued research is essential to further elucidate the mechanisms underlying CRS and to develop innovative treatments for this debilitating condition.
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Most relevant research papers on this topic
Adult chronic rhinosinusitis
Chronic rhinosinusitis (CRS) affects over 10% of adults in Europe and the USA, with facial pain and loss of smell being the most distinguishing symptoms.
Highly CitedEnvironmental air pollution and chronic rhinosinusitis: A systematic review
Environmental air pollution may contribute to the onset and severity of chronic rhinosinusitis by impacting the inflammatory component of the disease process.
Systematic Review
Rigorous JournalPathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes.
Chronic rhinosinusitis (CRS) is a heterogeneous disorder with distinct endotypes, each with distinct immune responses and different responses to medical and surgical treatment.
Systematic ReviewHighly CitedBacterial community collapse: a meta‐analysis of the sinonasal microbiota in chronic rhinosinusitis
Chronic rhinosinusitis patients have a dysbiotic bacterial community, with increased dispersion, lower diversity, and increased abundance of Corynebacterium bacteria, highlighting the importance of Burkholderia and Propionibacterium as gatekeepers.
Meta-AnalysisHighly CitedBiologics for chronic rhinosinusitis.
Biologics, such as dupilumab, can improve health-related quality of life and reduce symptom severity in chronic rhinosinusitis patients.
Systematic Review
Very Rigorous JournalHighly CitedOsteitis and chronic rhinosinusitis: a review of the current literature
Osteitis is an associated finding in chronic rhinosinusitis, but its cause and effect in this condition remain unclear.
Systematic ReviewRigorous JournalOccupational and environmental risk factors for chronic rhinosinusitis: a systematic review
Hazardous occupational and environmental exposures may play a role in chronic rhinosinusitis, with a multifactorial etiology potentially including these factors.
Systematic ReviewSCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases.
The concept of "Severe Chronic Upper Airway Disease" (SCUAD) highlights patients with persistent inflammation and symptoms despite guideline-driven pharmacologic treatment, aiding in research on definition, diagnosis, and pathophysiology of rhinitis and rhinosinusitis.
Systematic ReviewAdult Chronic Rhinosinusitis: Definitions, Diagnosis, Epidemiology, and Pathophysiology
A new, more specific definition of chronic rhinosinusitis has been developed, aiming to improve research and treatment efforts for this group of disorders.
Literature ReviewHighly CitedICON: chronic rhinosinusitis
This International Consensus on Chronic Rhinosinusitis highlights key common messages from existing guidelines, differences in recommendations, and gaps in our current knowledge, providing a concise reference for managing this complex disease.
Rigorous JournalHighly Cited