Adult chronic rhinosinusitis

Abstract

Chronic rhinosinusitis (CRS), that is, inflammation of the mucosa of the nose and paranasal sinuses for at least 12 weeks, occurs in >10% of adults in Europe and the USA and poses a substantial global health and economic burden. Common symptoms include facial pain or pressure, nasal discharge, congestion, and hyposmia or anosmia (Fig. 1). Patients with CRS may also have other inflammatory airway conditions such as asthma and allergic rhinitis. CRS can be differentiated into disease without nasal polyps (CRSsNP) and disease with nasal polyps (CRSwNP) based on nasal endoscopic findings. Both CRSsNP and CRSwNP have distinct symptoms, CT findings, treatments, and risks of recurrence and comorbid asthma 1. In addition, both phenotypes are characterized by structural remodelling (with collagen and fibrin deposition) and inflammation, and have combinations of type 1, 3 and/or type 2 inflammatory signatures that vary between diseases (Table 1). The inflammatory signatures determine the CRS endotype, which affects disease severity, comorbidity, prognosis and response to treatment 2. Our understanding the pathophysiology of CRS has evolved from impaired ventilation and drainage of the sinus cavities to a mucosal concept, which focuses on the immunology of the sinus mucosa and its deviation. Indeed, non-type 2 CRSsNP and type 2 CRSwNP are the two ends of a spectrum of disease that require different pharmacological and, eventually, biologic treatments in addition to different surgical approaches from mucosa-sparing functional surgery to mucosa-removing reboot surgery. With the advent of monoclonal antibodies targeting type 2 key immune regulators and effectors, CRS, in particular uncontrolled severe CRSwNP, will likely turn into a disease often controlled by biologics, which can be combined with tailored surgery if necessary. The mucosal concept based on endotyping may allow a precision treatment approach for all patient groups with CRS. This Primer provides a classical overview on CRS, covering state-of-the art clinical topics ranging from epidemiology to prevention and from diagnosis to pharma cological and surgical management of the disease. Of note, this Primer also discusses the role of immunology of the sinus mucosa and the interaction with offenders, such as Staphylococcus aureus, that leads to severe CRSwNP. In addition, the therapeutic principles targeting immune reactions in CRSwNP are discussed. Epidemiology CRS was thought to be one of most common diseases, imparting a substantial burden on individuals and society; however, the global epidemiology has only recently been understood. Objective diagnostic tools, such as nasal endoscopy or sinus CT, are recommended to confirm the diagnosis of CRS in clinical settings but are difficult to apply in large-scale population studies. Furthermore, symptom-based diagnosis may not be highly precise, as ~40% of patients with a symptom-based diagnosis show no endoscopic or radiologic evidence for the disease 3. However, the introduction Hyposmia Reduced ability to smell. Anosmi...

The basic immunology of asthma

“…The non-Th2 form is often associated with obesity, aging, and smoking. The Th2-associated form is often accompanied by recurrent and chronic rhinosinusitis with nasal polyps (CRSwNP) and with sensitivity to aspirin and can be associated with high eosinophil numbers in the airways (Bachert et al, 2020).…”

A rich meconium metabolome in human infants is associated with early-life gut microbiota composition and reduced allergic sensitization

“… 6 Alarmingly, atopic disorders, including eczema (atopic dermatitis), food allergy, asthma, and allergic rhinitis, are currently estimated to affect up to 30% of the population, with many children experiencing a lifelong burden. 7 , 8 , 9 , 10 …”

“…6 Alarmingly, atopic disorders, including eczema (atopic dermatitis), food allergy, asthma, and allergic rhinitis, are currently estimated to affect up to 30% of the population, with many children experiencing a lifelong burden. [7][8][9][10] Reduced colonization of beneficial early-life microbes is linked to a number of IgE-mediated disorders; however, how this early-life microbial community is formed is only just now being understood. [11][12][13] Furthermore, whether this phenomenon is limited to the postnatal early-life window has been challenged as studies reveal prenatal factors capable of influencing both microbiota composition and immune development.…”

Neutrophils Affect IL-33 Processing in Response to the Respiratory Allergen Alternaria alternata

“…Severe asthma and chronic rhinosinusitis (CRS) with nasal polyps remain the most severe and often uncontrolled extremes of type 2 inflammatory diseases of the upper and lower airways (1,2). Type 2 inflammatory responses are characterized by the production of cytokines, such as IL-4, IL-5, and IL-13, secreted by classic Th2 cells; and by innate immune cells, such as group 2 innate lymphoid cells (ILC2s), basophils, eosinophils, and mast cells.…”