Chronic rhinosinusitis (CRS) is characterized by inflammation in the nose and paranasal sinuses lasting a minimum of 12 weeks. Depending on whether nasal polyps are present, CRS can be categorized into two types: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP is marked by high tissue eosinophilia and an increase in T helper (Th)-2 cytokine expression. In contrast, CRSsNP is typified by Th-1 polarization and less eosinophilic infiltration. The EPOS2020 steering has decided to examine CRS from the perspective of primary and secondary classifications, further subdividing each based on the anatomical spread of the disease into localized and diffuse categories. In the case of primary CRS, the disease is categorized based on the predominance of endotypes, specifically type 2 or non-type 2. Key symptoms of CRS encompass anterior and/or posterior mucopurulent nasal discharge, nasal blockage, facial discomfort/pressure/fullness, and a diminished sense of smell (hyposmia or anosmia). Certain alarming symptoms, such as unilateral symptoms, blood-tinged rhinorrhea, orbital symptoms, swelling of the forehead, and specific neurological signs, call for immediate medical attention. As per prevailing clinical guidelines, the primary treatment for CRS involves intranasal corticosteroids. For patients who do not respond adequately to conservative treatment, endoscopic sinus surgery is suggested. Lately, biologics have emerged as a potential treatment option for CRSwNP patients who have a recalcitrant disease.

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Chronic Rhinosinusitis

  • Nikolaos Tsetsos

摘要

Chronic rhinosinusitis (CRS) is characterized by inflammation in the nose and paranasal sinuses lasting a minimum of 12 weeks. Depending on whether nasal polyps are present, CRS can be categorized into two types: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP is marked by high tissue eosinophilia and an increase in T helper (Th)-2 cytokine expression. In contrast, CRSsNP is typified by Th-1 polarization and less eosinophilic infiltration. The EPOS2020 steering has decided to examine CRS from the perspective of primary and secondary classifications, further subdividing each based on the anatomical spread of the disease into localized and diffuse categories. In the case of primary CRS, the disease is categorized based on the predominance of endotypes, specifically type 2 or non-type 2. Key symptoms of CRS encompass anterior and/or posterior mucopurulent nasal discharge, nasal blockage, facial discomfort/pressure/fullness, and a diminished sense of smell (hyposmia or anosmia). Certain alarming symptoms, such as unilateral symptoms, blood-tinged rhinorrhea, orbital symptoms, swelling of the forehead, and specific neurological signs, call for immediate medical attention. As per prevailing clinical guidelines, the primary treatment for CRS involves intranasal corticosteroids. For patients who do not respond adequately to conservative treatment, endoscopic sinus surgery is suggested. Lately, biologics have emerged as a potential treatment option for CRSwNP patients who have a recalcitrant disease.