Chronic Rhinosinusitis: Pathophysiology, Clinical Management, and Emerging Therapeutic Approaches

Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the nasal and paranasal sinus mucosa, lasting for more than 12 weeks despite medical management. It is characterized by nasal obstruction, facial pressure or pain, nasal discharge, and reduction or loss of smell. CRS can be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP), each with distinct immunological and clinical profiles. The condition significantly affects quality of life and is often associated with comorbidities such as asthma, allergic rhinitis, and sleep disturbances. Current management strategies include saline irrigation, intranasal corticosteroids, antibiotics when indicated, and in refractory cases, endoscopic sinus surgery. Recent research highlights the role of type 2 inflammation, microbial dysbiosis, and immune dysregulation in CRS pathogenesis, paving the way for targeted biologic therapies and personalized treatment approaches.