On this page
Quick Reference
Overview and Recommendations
Background
- •CRS affects approximately 5% of the adult population, with significant geographic variation, and is defined by persistent inflammation of the sinonasal mucosa lasting 12 weeks or longer. The disease is not a single entity but encompasses distinct phenotypes, CRS with nasal polyps (CRSwNP) and without (CRSsNP), that differ in pathophysiology, clinical presentation, and treatment response.
- •The underlying inflammatory endotype determines disease behavior: type 2 inflammation (driven by IL-4, IL-5, IL-13, and epithelial alarmins like TSLP) dominates CRSwNP and is associated with eosinophilia, polyps, and comorbid asthma or NSAID intolerance. Non-type 2 CRS (Th1/Th17) is more common in CRSsNP and may be linked to neutrophilic inflammation.
- •CRS carries substantial morbidity, including olfactory dysfunction (up to 78% on objective testing), sleep disturbance, and a bidirectional relationship with depression and anxiety. Untreated, only 8% of patients achieve disease control, and the annual cost of care is high.
- •Key modifiable risk factors include obesity (OR 1.33), smoking, and occupational exposures; asthma and allergic rhinitis are common comorbidities. Mendelian randomization has confirmed causal roles for sedentary time, depression, and GERD.
- •The paradigm of CRS management has shifted from broad antimicrobial use to phenotype- and endotype-directed therapy, with biologics targeting specific inflammatory pathways for severe disease.
Evaluation
- •Suspect CRS in any patient with two or more cardinal symptoms, nasal obstruction, anterior/posterior mucopurulent discharge, facial pain/pressure, or olfactory disturbance, persisting for ≥12 weeks.
- •Ask about the duration and quality of facial pain (bilateral, dull ache worse with bending), severity of nasal congestion, and any fluctuation in smell. Also inquire about asthma, NSAID intolerance, and history of sinus surgery.
- •Examine the nasal cavity with anterior rhinoscopy and, most importantly, nasal endoscopy to visualize the middle meatus, sphenoethmoidal recess, and olfactory cleft. Endoscopic findings of polyps, mucopurulent discharge, or mucosal edema confirm the diagnosis.
- •Document the endoscopic severity using the Modified Lund-Kennedy score, which grades polyps, edema, and discharge on a 0-2 scale per side (total 0-12). The Nasal Polyp Score (0-4 per nostril) is used for polyp-specific assessment.
- •Order a non-contrast coronal CT of the paranasal sinuses if endoscopy is not diagnostic or if surgical planning is needed. A Lund-Mackay score ≥4 is consistent with CRS; a score of 0 essentially excludes it.
- •Assess for the eosinophilic endotype with blood eosinophil count (cutoff ≥0.16 × 10⁹/L has 85% sensitivity for eosinophilic CRS), total IgE, and fractional exhaled nitric oxide (FeNO). Tissue biopsy at surgery can confirm >70 eosinophils/HPF.
- •Consider imaging for complications if there is unilateral disease, orbital signs, forehead swelling, or neurological symptoms. Contrast-enhanced CT or MRI is indicated for suspected fungal ball, neoplasm, or intracranial extension.
- •Screen for associated conditions: in patients with nasal crusting, septal perforation, or saddle-nose, check c-ANCA for granulomatosis with polyangiitis. In children or adults with recurrent pneumonia, evaluate for cystic fibrosis (sweat chloride, CFTR genetics) or primary ciliary dyskinesia (nasal nitric oxide, genetics).
- •Evaluate symptom burden with the SNOT-22 questionnaire; a clinically meaningful change is ≥8.9 points. Also assess sleep quality (Sleep-SNOT subdomain) and screen for depression (PHQ-2).
- •Differentiate from other causes of nasal obstruction: allergic rhinitis, structural nasal obstruction, and odontogenic sinusitis (unilateral disease with foul odor should prompt dental evaluation).
Management
- •Initiate first-line medical therapy with intranasal corticosteroids (e.g., fluticasone 2 sprays each nostril daily) and large-volume saline irrigation (≥150 mL per nostril once or twice daily). These are the cornerstone of treatment for all phenotypes.
- •For patients with CRSwNP, consider adding high-volume steroid irrigations (e.g., budesonide 0.5 mg/2 mL in 240 mL saline twice daily) to reduce polyp size and improve symptoms; this is especially effective after surgery.
- •Prescribe a short course of oral corticosteroids (e.g., prednisone 30-40 mg daily for 5-10 days) only for acute exacerbations of CRSwNP or allergic fungal sinusitis; avoid routine use in CRSsNP as it provides no benefit and increases adverse effects.
- •For acute exacerbations (AECRS), use watchful waiting for mild cases; if antibiotics are prescribed, give amoxicillin with or without clavulanate 500-875 mg BID for 5-10 days. For recurrent or refractory cases, obtain culture-directed antibiotics via middle meatal swab.
- •Refer for endoscopic sinus surgery (ESS) when symptoms persist despite 8-12 weeks of optimal medical therapy, or when complications (orbital abscess, Pott's puffy tumor, intracranial extension) are present. Do not require a predefined duration of medical therapy before considering surgery.
- •Perform ESS using a graded approach; the LOEM system (Lamella Ostium Extent Mucosa) guides extent. Extended procedures (LOEM 3-4) reduce revision rates and improve symptom scores compared to limited surgery.
- •In the perioperative period, continue saline irrigation and consider steroid-releasing sinus implants to reduce adhesions and polyp recurrence. Avoid routine postoperative oral corticosteroids in CRS without polyps.
- •For patients with severe CRSwNP (high polyp burden, recurrence after surgery, or requiring systemic corticosteroids), initiate biologic therapy. First-line options include dupilumab 300 mg subcutaneously every 2 weeks, mepolizumab 100 mg every 4 weeks, or tezepelumab 210 mg every 4 weeks. These significantly reduce polyp size, improve smell, and lower the need for surgery.
- •Monitor response to biologics with SNOT-22, Nasal Polyp Score, and olfactory testing at 16-24 weeks. Discontinue if no improvement after 6 months; consider switching to another biologic if inadequate response.
- •Avoid using systemic or topical antifungals for routine CRS, they show no benefit and increase adverse events. Do not prescribe macrolide antibiotics (e.g., clarithromycin) for CRS, as the MACRO trial found no benefit over placebo.
- •Manage comorbidities: treat asthma and allergic rhinitis concurrently, refer for sleep study if Sleep-SNOT ≥17.5, and screen for pneumococcal antibody deficiency (consider PPSV23 vaccination if nonprotective titers).
- •Counsel patients that CRS is a chronic condition: only 35-40% achieve well-controlled disease, and polyp recurrence after ESS is 35-40% at 18 months. However, biologics can achieve remission in up to 77% of patients.
- •Discharge criteria for acute exacerbations: resolution of fever, improvement in pain, and no signs of orbital or intracranial complications. For planned surgery, ensure patient understands the need for postoperative irrigations and follow-up.
Board Review — High Yield
- •Type 2 inflammation, Dominates CRSwNP; driven by IL-4, IL-5, IL-13; responds to dupilumab, mepolizumab, tezepelumab.
- •Lund-Mackay score ≥4, Radiographic criterion for CRS on CT.
- •Modified Lund-Kennedy score, Preferred endoscopic grading system; excludes scarring/crusting, highest reliability.
- •SNOT-22 MCID, ≥8.9 points defines clinically meaningful change.
- •Dupilumab 300 mg q2w, Most effective biologic for CRSwNP in network meta-analysis.
- •MACRO trial, Clarithromycin no better than placebo for CRS; ESS superior to continued medical therapy alone.
- •EPOS 2020 uncontrolled CRS, ≥3 of: symptoms, rescue medication, mucosal disease in the prior month.
- •Pott's puffy tumor, Frontal bone abscess with intracranial involvement in 38% of adults; requires urgent surgical drainage.
- •CFTR modulators (elexacaftor-tezacaftor-ivacaftor), First-line for CRS in cystic fibrosis; improve sinonasal and pulmonary outcomes.
- •Biologic therapy reduces surgery need, Tezepelumab reduced surgery rate to 0.5% vs 22.1% placebo in WAYPOINT trial.
Deep Dive — Evidence Details
Definition, Classification and Anatomic Localization
- ▸CRS is defined by inflammation of the sinonasal mucosa lasting ≥12 weeks, with two major phenotypes: CRSwNP and CRSsNP.
- ▸Contemporary classification adds anatomical distribution (local vs diffuse) and inflammatory endotype (type 2 vs non-type 2), which guides biologic therapy.
- ▸Disease control, as per EPOS, is a composite of symptoms, medication use, and endoscopy, used to measure treatment response.
Chronic rhinosinusitis (CRS) is a chronic inflammatory condition of the sinonasal mucosa, defined by persistent inflammation of the nose and paranasal sinuses lasting 12 weeks or longer, with distinct phenotypes that differ in pathophysiology and [5]A1c[19]A1c.
Also Called: Chronic sinusitis, rhinosinusitis, CRS, CRSwNP (with ), CRSsNP (without nasal polyps), AECRS (acute exacerbation of CRS).
Anatomic Compartment
CRS involves the osteomeatal complex, a functional unit comprising the maxillary sinus ostium, ethmoid infundibulum, and middle meatus. Obstruction of this narrow drainage pathway by inflammation or polyps is central to pathogenesis [17]D5. The paranasal sinuses (frontal, maxillary, ethmoid, sphenoid) are lined by respiratory epithelium, and contiguous disease can extend to the skull base, orbit, and intracranial cavity [29]D5.
Classification Systems
Classification has evolved from a simple dichotomy of CRS with or without nasal polyps to a more nuanced framework incorporating anatomical distribution and inflammatory endotype [17]D5. The International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) [5]A1c[19]A1c and the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) [14]D5 provide the dominant classification schemes.
| Phenotype | Key Feature | Endotype/Associated Marker |
|---|---|---|
| CRSsNP | No visible polyps on endoscopy; primarily neutrophilic inflammation | Non-type 2 (mixed Th1/Th17) [5]A1c |
| CRSwNP | Bilateral polypoid mucosa; eosinophilic or mixed inflammation | Type 2 (IL-4, IL-5, IL-13, IgE, periostin) [34]A1a |
| AECRS | Transient worsening of symptoms returning to baseline [26]C4 | Often type 2 predominant; requires systemic corticosteroids or |
| Primary diffuse CRS | Bilateral, non-localized disease; most common in adults [17]D5 | Type 2 or non-type 2; may be associated with asthma, NSAID intolerance [44]A1a |
| Primary local CRS | Unilateral, confined to one functional unit (e.g., odontogenic sinusitis) [20]A1c | Often non-type 2; requires dental evaluation [20]A1c |
| Secondary CRS | Defined by underlying systemic disease (e.g., cystic fibrosis, primary ciliary dyskinesia, immunodeficiency) [8]A1c[9]B2a[10]C4 | Variable; CF related to CFTR mutation, PCD to ciliary dyskinesia [10]C4 |
Disease control is defined per EPOS as a composite of symptom burden, need for rescue medication, and endoscopic findings; it is categorized as controlled, partially controlled, or uncontrolled [14]D5.
Clinical significance: CRS affects approximately 2.5 per 1000 population per year (incidence) and 18.8-23.3 per 1000 (prevalence) [35]B2b, with substantial geographic variation [24]B2c and growing recognition of associations with obesity [12]B3b, occupational exposures [7]B2a, and lower airway disease (asthma, AERD, eosinophilic esophagitis) [46]A1a[47]B2b. Underutilization of guideline-recommended intranasal steroids remains a quality gap [40]B2b.
The heterogeneity of definitions across studies [3]D5 and the variability in surgical categorisation [13]B2a highlight the need for standardised reporting. The LOEM (Lamella Ostium Extent Mucosa) system [13]B2a and Postoperative Polyp Scale (POPS) [42]D5 have been proposed to improve comparability of surgical outcomes. For a detailed discussion of the molecular pathways driving these phenotypes, the reader is directed to the next section on Pathophysiology and Mechanism.
Pearl: When evaluating a patient with CRS, routinely classify by both phenotype (polyps vs no polyps) and endotype (type 2 vs non-type 2), this directly predicts response to intranasal steroids, biologics, and surgical extent [5]A1c[17]D5[30]D5.
| Phenotype | Key Feature | Endotype/Associated Marker |
|---|---|---|
| CRSsNP | No visible polyps | Non-type 2 (mixed Th1/Th17) |
| CRSwNP | Bilateral polyps | Type 2 (IL-4, IL-5, IL-13, IgE, periostin) |
| AECRS | Transient worsening to baseline | Often type 2 |
| Primary diffuse CRS | Bilateral, non-localized | Type 2 or non-type 2 |
| Primary local CRS | Unilateral, functional unit | Often non-type 2 |
| Secondary CRS | Underlying systemic disease | Variable (CF, PCD, immunodeficiency) |
Pathophysiology and Mechanism
- ▸CRS endotypes are defined by type 2 (IL-4/IL-5/IL-13, eosinophilic) versus non-type 2 (Th1/Th17, neutrophilic) inflammation, with type 2 predominating in CRSwNP and driving polyp formation.
- ▸Epithelial barrier dysfunction and release of alarmins (TSLP, IL-25, IL-33) initiate and amplify type 2 inflammation via ILC2s and Th2 cells, creating a self-perpetuating loop.
- ▸Microbial dysbiosis, S. aureus superantigens, and biofilms contribute to recalcitrant inflammation, while environmental factors (cigarette smoke, air pollutants, obesity) and genetic modifiers modulate disease risk and severity.
From the classification of CRS into phenotypes and endotypes, the mechanistic underpinnings reveal a spectrum of inflammatory dysregulation that begins at the sinonasal epithelial barrier and extends into adaptive immunity, tissue remodeling, and microbial ecology. The disease is not a single entity but a group of disorders driven by distinct pathophysiologic pathways, broadly divided into type 2 and non-type 2 inflammation, which dictate clinical presentation, polyp formation, and treatment response [17]D5[50]A1a.
Endotype-driven inflammation: Type 2 and non-type 2 pathways
Type 2-skewed inflammation dominates CRSwNP, marked by elevated (IL-5), (IL-4), (IL-13), and local (IgE) production [50]A1a[61]D5. These cytokines orchestrate eosinophil recruitment, activation, and survival, with IL-5 critical for eosinophil differentiation and trafficking [61]D5. Eosinophils in turn secrete granule proteins, enzymes, and oxidative products that damage epithelium and perpetuate inflammation [61]D5. The presence of heterogeneous endotypes, eosinophilic versus noneosinophilic, correlates with distinct clinical severity: eosinophilic CRSwNP shows higher CT scores, endoscopic scores, blood eosinophil percentages, and polyp recurrence rates [77]C4. Non-type 2 CRS (often CRSsNP) is associated with / pathways, neutrophilic infiltrates, and cytokines such as (IFN-γ) and (IL-17), though the precise molecular drivers are less well defined [17]D5[50]A1a.
Epithelial barrier dysfunction and alarmin release
Central to CRS pathogenesis is sinonasal epithelial barrier disruption. Damaged or activated epithelial cells release alarmins, (TSLP), (IL-25), and (IL-33), which initiate and amplify type 2 inflammation by activating (ILC2s), dendritic cells, and mast cells [50]A1a[87]D5. TSLP, in particular, is upregulated in eosinophilic CRS and correlates with tissue eosinophil counts [74]D5. This alarmin-ILC2-Th2 axis creates a self-sustaining inflammatory loop. Short-chain fatty acids (SCFAs) such as propionic acid suppress TSLP expression and eosinophil survival in vitro, suggesting a potential therapeutic avenue [74]D5.
Role of microbial dysbiosis and biofilms
The sinonasal microbiome is qualitatively and quantitatively altered in CRS. Bacterial diversity is reduced, and specific taxa differ between endotypes: and are enriched in eosinophilic CRSwNP, while and abundances shift [77]C4[78]B3b. The mycobiome also shows altered beta diversity, with distinct fungal communities in CRS versus controls [78]B3b. Staphylococcus aureus superantigens (enterotoxins) act as immune activators, driving polyclonal IgE production and local inflammation; their presence increases the odds of CRSwNP (OR 12.07 for superantigen detection) and correlates with higher CT scores and CD4+ T-cell counts [54]B3a. Biofilms, structured microbial communities encased in matrix, are found in a substantial subset of recalcitrant CRS and contribute to treatment resistance by impeding antibiotic penetration and modulating immune responses [69]D5[87]D5. Biofilm-derived pathogen-associated molecular patterns (PAMPs) trigger alarmin release, perpetuating the type 2 loop [87]D5.
Genetic and environmental modifiers
Causal evidence from Mendelian randomization supports a role for daily cigarette consumption (OR 1.15), asthma (OR 1.45, 95% CI 1.31-1.60), (OR 4.77), and BMI (OR 1.05, 95% CI 1.00-1.09) in CRS development [82]B2c. Cigarette smoke directly impairs ciliary beat frequency and releases inflammatory mediators from sinonasal epithelium [49]A1a. Long-term residential exposure to traffic-related pollutants (NO₂, benzene, lead) is associated with increased CRS risk and distinct cytokine signatures: NO₂ elevates type 2 cytokines (IL-4, IL-5, IL-13), while benzene and lead promote non-type 2 profiles [71]B3b. Obesity is linked to a 33% higher odds of CRS (OR 1.33), possibly through leptin-mediated inflammation [48]A1a.
Molecular and cellular mediators of tissue remodeling
Persistent inflammation drives structural changes including goblet cell hyperplasia, subepithelial fibrosis, stromal edema, and osteitis (new bone formation) [29]D5[67]D5. , a matricellular protein upregulated in response to IL-4/IL-13, is consistently elevated in CRSwNP tissue and serum, particularly in eosinophilic endotypes, and correlates with disease severity [52]D5. (MMP-9) is linked to tissue remodeling and postoperative healing quality [67]D5. Recent evidence implicates ferroptosis, a form of regulated cell death, with dysregulated expression of GPX2 and CDO1 in nasal polyps [81]D5. The is activated in nasal epithelial cells, T lymphocytes, and macrophages, promoting IL-1β and IL-18 release and pyroptotic cell death, which may amplify mucosal inflammation [84]D5[85]D5. (miR-125b, miR-155, miR-21, miR-145-5p) are differentially expressed in CRS endotypes and regulate inflammation and epithelial-mesenchymal transition [86]D5.
The immune hyperresponsiveness hypothesis
An emerging paradigm posits that in many CRS patients, the disease results not from an exogenous pathogen but from an immune hyperresponsiveness to commensal organisms. Peripheral blood leukocytes from CRS patients produce IL-5 when exposed to microbiota from healthy controls, whereas leukocytes from healthy individuals do not, indicating a dysregulated adaptive immune response to the normal microbiome [72]B3b. This aligns with the observation that the sinonasal microbiome of CRS patients is qualitatively similar to controls but quantitatively increased, and that the immune system, not the microbes, is the primary driver of chronic inflammation [72]B3b.
| Mediator / Pathway | Key Role in CRS | Endotype Association |
|---|---|---|
| IL-4, IL-5, IL-13 | Eosinophil activation, IgE class switching, goblet cell metaplasia | Type 2 (CRSwNP) |
| TSLP, IL-25, IL-33 | Epithelial alarmins → ILC2/Th2 activation | Type 2 |
| IFN-γ, IL-17 | Neutrophil recruitment, epithelial barrier disruption | Non-type 2 (CRSsNP) |
| Periostin | Matricellular protein, biomarker of type 2 remodeling | Type 2 (eosinophilic) |
| S. aureus superantigens | Polyclonal IgE, T-cell activation, severity | CRSwNP |
| NLRP3 inflammasome | IL-1β/IL-18 release, pyroptosis, mucosal inflammation | Both endotypes |
| Short-chain fatty acids | Suppress TSLP, reduce eosinophil survival | Potential therapeutic target in ECRS |
Pearl: The clinical distinction between CRSwNP and CRSsNP is driven by underlying endotype, type 2 inflammation (IL-4/IL-5/IL-13, alarmins, eosinophilia) dictates polyp formation and predicts response to biologic therapy, while non-type 2 CRS requires different strategies targeting neutrophilic or mixed pathways.
Epidemiology, Etiology and Risk Factors
- ▸CRS prevalence is 4.3-10.4% in general populations; incidence is approximately 2.5 per 1000 per year.
- ▸Major modifiable risk factors include smoking (OR 1.35), obesity (OR 1.33), and allergic rhinitis (OR 4.77).
- ▸Female sex predisposes to CRSsNP; male sex to CRSwNP; AFRS disproportionately affects Black and underinsured patients.
The inflammatory cascade described above does not occur in isolation; its clinical expression is shaped by a constellation of demographic, genetic, and environmental factors that determine who develops CRS and how it progresses.
Incidence and Prevalence
CRS affects 4.3% to 10.4% of adults in population-based studies from the USA, South Korea, and Spain [112]B2a. In a Canadian administrative cohort using a validated case definition, the mean age- and sex-standardized incidence was 2.5 per 1000 population per year, with a prevalence of 18.8 to 23.3 per 1000 that remained stable over a decade [35]B2b. Geographic variation within a single province was high, suggesting disparities in diagnosis or access [35]B2b.
Demographic Distribution
Female sex is associated with higher odds of CRS without (CRSsNP) (OR 1.44 for age <60 years; OR 1.32 for ≥60 years) but lower odds of CRS with nasal polyps (CRSwNP) (OR 0.63) [114]C4. Allergic fungal rhinosinusitis (AFRS), a distinct subtype, disproportionately affects Black patients (58.0% of AFRS vs 23.8% of CRSwNP and 13.0% of CRSsNP) and those who are uninsured or on Medicaid [93]A1a.
Risk Factors
| Factor | Odds Ratio / Relative Risk | Evidence Level |
|---|---|---|
| Obesity (BMI ≥30) | OR 1.33 (95% CI 1.17-1.51) [48]A1a; OR 1.53 for new-onset [129]B2b | 1a |
| Asthma | OR 1.45 (95% CI 1.31-1.60) [82]B2c | 2c |
| GERD | OR 1.36 (95% CI 1.18-1.57) [127]B2b | 2b |
| Sibling with pediatric CRS | HR 57.5 (p<10⁻⁸) [122]B2b | 2b |
| Pesticide exposure (residential) | OR 2.41 (95% CI 1.49-3.90) [117]C4 | 4 |
| Air pollution (NO₂, SO₂, PM₂.₅) | Increased outpatient visits [110]B2c | 2c |
| H. pylori in sinonasal tissue | Detected in 37.1% of polyps [108]B3a | 3a |
Smoking and obesity are the most important modifiable risk factors. Current smoking independently predicts higher CT severity in non-eosinophilic CRS but not in eosinophilic CRS [123]C4. Bidirectional associations exist with depression (HR 1.40 for new-onset depression after CRS; HR 1.59 for new-onset CRS after depression) and anxiety (HR 2.79 and 2.37, respectively) [113]B2b. CRS also increases the risk of new-onset asthma (OR 1.74), bronchiectasis (OR 1.87), (OR 1.73), and obstructive sleep apnea (OR 1.91) [105]B2b.
Special Populations
Pediatric CRS is common and often linked to adenoiditis and immune deficiency [66]D5. Patients with have hypoplastic sinuses and immune dysfunction predisposing to CRS [115]D5. In lung transplant recipients, CRS prevalence is 7.2% pre-transplant and 13.8% post-transplant, with rates exceeding 50% in those with bronchiectasis or [124]C4. patients have a 2-3 fold higher prevalence of CRS-type symptoms (21.8-25.1% vs 8.71% in the general population) [47]B2b.
These epidemiological patterns set the stage for the clinical presentation, where symptom burden varies by phenotype and comorbidity.
Pearl: Female sex predisposes to CRSsNP; male sex to CRSwNP; AFRS disproportionately affects Black and underinsured patients.
Clinical Presentation
- ▸Facial pain/pressure is moderate or worse in 56.4% of nonpolypoid CRS versus 29.8% of polypoid disease, a key phenotypic distinction.
- ▸Olfactory dysfunction affects 30-78% of CRS patients on objective testing, with worse scores in CRSwNP; olfactory fluctuation is a strong clue to sinonasal origin.
- ▸Depression is present in 24.4% of CRS patients and is associated with worse symptom burden and healthcare utilization; treating CRS improves depression scores.
These risk factors shape a clinical picture that, while variable, follows recognizable patterns. The cardinal symptoms of CRS, nasal obstruction, anterior or posterior mucopurulent discharge, facial pain/pressure, and olfactory disturbance, must be present for ≥12 weeks to meet diagnostic criteria [133]A1c.
Presenting Symptoms
Nasal obstruction and discharge are nearly universal, but the severity of other symptoms differs by phenotype. Facial pain/pressure, often described as a dull ache over the maxillary or frontal sinuses, is a moderate problem or worse in 56.4% of patients without (CRSsNP) compared to 29.8% of those with polyps (CRSwNP) [91]A1a. This difference is clinically significant and helps guide initial suspicion. The pain is typically bilateral and worse with bending forward or lying down.
Olfactory dysfunction is the most underappreciated symptom. Using validated testing, prevalence ranges from 30% (Brief Smell Identification Test) to 78% (Sniffin' Sticks total score) [95]A1a. Patients with CRSwNP have significantly worse smell scores than those with CRSsNP, with a mean difference of 8.7 points on the composite TDI score [159]C4. Olfactory fluctuation, periods of improvement and worsening, is strongly associated with sinonasal disease (42.4% prevalence vs 28% postinfectious) and should prompt evaluation for CRS [73]C4.
Taste dysfunction is also common, affecting 28% to 34% of patients on objective testing [164]C4[2]B2a. Importantly, objective taste loss does not correlate with olfactory dysfunction, suggesting a direct inflammatory effect on gustatory pathways [2]B2a.
Sleep disturbance is frequent, driven by nasal obstruction, postnasal drip, and the systemic inflammatory milieu [146]D5. Depression is a major comorbidity: 24.4% of CRS patients screen positive on the PHQ-2, and those with depression have worse SNOT-22 scores (mean 64.5 vs 47.6) and more antibiotic and corticosteroid use [158]B2b.
Phenotypic Variants
CRS is not a single disease. The table below outlines the key subtypes and their distinguishing features.
| Variant | Key Features | Frequency / Notes |
|---|---|---|
| CRS without nasal polyps (CRSsNP) | Bilateral facial pain/pressure more prominent; less severe smell loss; moderate to severe pain in 56% | Most common phenotype [91]A1a |
| CRS with nasal polyps (CRSwNP) | Severe nasal obstruction, anosmia, less pain (moderate in 30%); polyp recurrence after ESS in 35-40% at 6-18 months | Type 2 inflammation; prior ESS and worse preoperative polyposis predict recurrence (OR 2.6 and 1.4) [121]B2b |
| (AERD) | Triad of CRSwNP, asthma, NSAID hypersensitivity; polyps regrow rapidly; anosmia early | 0.3-0.9% of population; surgery improves symptoms but medical therapy is essential [138]B2a[152]D5 |
| Allergic fungal rhinosinusitis (AFRS) | Unilateral or bilateral polyps with eosinophilic mucin; often in young adults; mean age 27.7 years; male predominance (52%) | Aspergillus flavus most common (32.8%); recurrence rate 19.4% after surgery [167]C4 |
| Odontogenic sinusitis (ODS) | Unilateral maxillary sinusitis; foul odor; unilateral purulent discharge; dental pathology on imaging | Requires dental referral; microbes and Th1 cytokine profile (IFNγ, TNFα, IL-6, IL-8 elevated) [20]A1c[163]B3b |
| Cystic fibrosis CRS (CF-CRS) | Nasal polyps in 50-60%; hyposmia/anosmia common; often bilateral pansinusitis; neutrophilic inflammation | CFTR modulators improve sinonasal outcomes [53]D5[155]B2a |
| Granulomatosis with polyangiitis (GPA) | Nasal crusting, epistaxis, septal perforation, saddle-nose deformity; ; PR3-ANCA positive in >85% | Destructive lesions predict renal involvement; misdiagnosis as CRS is common [156]C4 |
Red Flags and Atypical Presentations
Certain symptoms demand urgent evaluation. Unilateral symptoms, especially facial pain, nasal obstruction, or epistaxis, raise suspicion for odontogenic sinusitis, fungal ball, or neoplasm. Saddle-nose deformity or septal perforation should prompt ANCA testing for GPA [156]C4. Orbital swelling, diplopia, or vision changes indicate orbital complications requiring immediate surgical referral.
Intracranial pressure elevation can mimic CRS with bilateral facial pressure, ear fullness, and , and should be considered when symptoms do not respond to conventional intranasal therapies [153]D5.
Pearl: Patients with CRSsNP present with more prominent facial pain and pressure than those with CRSwNP, but the latter have worse olfactory loss and higher polyp recurrence after surgery. A unilateral presentation should always trigger a search for dental, fungal, or autoimmune causes.
Audiologic, Vestibular and Endoscopic Assessment
- ▸Nasal endoscopy with objective documentation of sinonasal inflammation is required to confirm the diagnosis of CRS (AAO-HNSF strong recommendation).
- ▸The Modified Lund-Kennedy (MLK) score, which excludes scarring and crusting, has the highest inter-rater reliability and best correlation with patient-reported outcomes.
- ▸Audiologic assessment (tympanometry, audiometry) is indicated in CRSwNP patients with ear symptoms, as otitis media with effusion is present in ~23% of severe cases and may improve with biologic therapy.
The clinical history and examination findings guide the need for objective confirmation of sinonasal inflammation. The office-based nasal endoscopy is the cornerstone for diagnosis and serial monitoring of chronic rhinosinusitis (CRS), providing direct visualization of the middle meatus, sphenoethmoidal recess, and olfactory cleft that cannot be adequately assessed by anterior rhinoscopy alone [133]A1c[135]A1c.
Nasal Endoscopy as the Diagnostic Standard
All high-quality international guidelines recommend nasal endoscopy to confirm the diagnosis of CRS [1]D5[133]A1c[135]A1c. The American Academy of Otolaryngology- and Neck Surgery Foundation (AAO-HNSF) 2025 guideline explicitly states that clinicians should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography [135]A1c. Diagnostic nasal endoscopy has a pooled sensitivity of 0.87 and specificity of 0.63 against CT as reference standard [168]C4. The lower specificity reflects that endoscopy may miss subtle mucosal changes or disease deep within sinuses, but its high sensitivity makes it an excellent first-line tool.
Endoscopic findings that confirm CRS include , mucopurulent discharge (anterior or posterior), and mucosal edema or obstruction of the middle meatus or sphenoethmoidal recess [133]A1c[135]A1c. The 2015 AAO-HNSF guideline update emphasized that objective documentation is required to distinguish CRS from non-inflammatory conditions such as or structural nasal obstruction [133]A1c. The 2025 update further reinforced that before considering sinus surgery, the surgeon must verify that established diagnostic criteria are met [134]A1c[137]A1c.
Endoscopic Scoring Systems
Several validated scoring systems standardize the endoscopic assessment for clinical practice and research. The Lund-Kennedy (LK) endoscopic score grades polyps, edema, discharge, scarring, and crusting on a 0-2 scale for each side, yielding a total score of 0-20 [160]B2b. The Modified Lund-Kennedy (MLK) score retains the subscores for polyps, edema, and discharge but eliminates scarring and crusting, which have poor inter-rater reliability and do not correlate with patient-reported outcomes [160]B2b. In a prospective study of 102 CRS patients, the MLK system showed the highest inter-rater and test-retest reliability of all compared systems and was the only system that correlated with the symptom subscore of the SNOT-22 in both unoperated and postoperative patients [160]B2b. The Perioperative Sinus Endoscopy (POSE) score and the Discharge, Inflammation, Polyp (DIP) score are alternatives, but the MLK score is the most practical for everyday use [160]B2b.
For polyp-specific assessment, the Nasal Polyp Score (NPS) grades polyp size from 0 (no polyps) to 4 (polyps filling the entire nasal cavity) for each side, with a total score of 0-8 [162]B2b[179]A1b. The NPS is the primary endpoint in most biologic trials. In the EVEREST head-to-head trial, dupilumab 300 mg every 2 weeks improved NPS by a mean of -2.25 (95% CI -2.65 to -1.85) versus omalizumab weight-tiered dosing at 24 weeks [179]A1b. The Olfactory Cleft Endoscopy Scale (OCES) grades inflammation of the olfactory cleft and independently predicts retronasal olfaction scores (r = -0.42, P < 0.001) [180]C4.
Correlation with Patient-Reported and Objective Outcomes
Endoscopic scores correlate only modestly with patient-reported quality of life. The LK and MLK scores show weak-to-moderate correlations with the SNOT-22, with the MLK system performing better [160]B2b[183]C4. In contrast, depression and anxiety scores (Hospital Anxiety and Depression Scale, HADS) have a moderate-to-very-strong correlation with the Rhinosinusitis Disability Index (RSDI) but no significant correlation with Lund-Kennedy endoscopic scores [183]C4. This dissociation highlights that endoscopy measures mucosal disease burden, while patient-reported outcomes are influenced by psychological comorbidity, sleep disturbance, and productivity loss [158]B2b[176]C4.
Endoscopic findings do predict surgical outcomes. Higher preoperative polyp scores and prior endoscopic sinus surgery are associated with higher risk of polyp recurrence after surgery: odds ratio 2.6 (95% CI 1.5-4.6) for prior ESS and 1.4 for worse preoperative polyposis severity [121]B2b. Postoperative endoscopy-guided , including steroid-impregnated bioabsorbable implants, significantly reduces POSE scores (weighted mean difference -1.88, 95% CI -2.32 to -1.43) and reduces adhesion formation and middle turbinate lateralization [174]A1a.
Audiologic and Vestibular Considerations
Audiologic assessment is not routinely performed in CRS but is indicated when otitis media with effusion (OME) is suspected, particularly in patients with type 2 inflammation (CRSwNP, asthma, ). In a secondary analysis of a randomized trial, 22.8% of patients with severe CRSwNP had pathological tympanometry at baseline, and mepolizumab treatment was associated with a trend toward reduced OME and significant improvement in self-reported otologic symptoms (COMOT-15 score, P < 0.05) [120]A1b. Biologic therapy targeting IL-4/IL-13 signaling also improved tympanometry and subjective ear examination in suspected eosinophilic otitis media [170]C4. Conductive hearing loss (air-bone gap) did not change significantly with treatment [120]A1b.
Vestibular assessment is not part of the standard CRS evaluation. However, if a patient complains of dizziness or imbalance, alternative diagnoses (e.g., benign paroxysmal positional vertigo, Ménière disease, or otitis media) should be pursued, as CRS itself does not directly cause vestibular dysfunction. The presence of CRS with nasal polyps and asthma raises suspicion for type 2 inflammation that may also involve the middle ear, warranting tympanometry and audiometry when ear symptoms are present [120]A1b[170]C4.
Pearl: When assessing a patient with CRS, perform nasal endoscopy at the initial visit and at each follow-up to document the presence and severity of polyps, edema, and discharge using the Modified Lund-Kennedy score, this provides a reliable, serial objective measure that correlates with treatment response and predicts escalation risk, but never rely on endoscopy alone to judge patient-perceived disease control, as psychological comorbidity is a major confounder.
| Scoring System | Components | Score Range | Key Features |
|---|---|---|---|
| Lund-Kennedy (LK) | Polyps, edema, discharge, scarring, crusting | 0-20 (each side 0-10) | Widely used; scarring and crusting have poor reliability |
| Modified Lund-Kennedy (MLK) | Polyps, edema, discharge | 0-12 (each side 0-6) | Excludes scarring/crusting; best inter-rater reliability and correlation with SNOT-22 [160]B2b |
| Nasal Polyp Score (NPS) | Polyp size 0-4 per nostril | 0-8 | Standard in biologic trials; primary endpoint in EVEREST [179]A1b |
| Olfactory Cleft Endoscopy Scale (OCES) | Inflammation of olfactory cleft | 0-4 (per side) | Independent predictor of retronasal olfaction [180]C4 |
| Perioperative Sinus Endoscopy (POSE) | Postoperative cavity appearance | Variable | Used in surgical outcome studies; less common in routine care |
Diagnostic Imaging, Tissue Sampling and Workup
- ▸Non-contrast sinus CT with Lund-Mackay scoring is the gold-standard imaging modality; a score ≥4 supports CRS, but CT alone cannot confirm the diagnosis because it correlates only weakly with symptoms.
- ▸Nasal endoscopy has high sensitivity (0.87) but moderate specificity (0.63) for detecting sinonasal inflammation; it satisfies the AAO-HNS objective-confirmation requirement.
- ▸Tissue eosinophil count ≥70/HPF on sinus mucosal biopsy is the gold standard for diagnosing eosinophilic CRS; preoperative systemic steroids can falsely lower this count and should be withheld if biopsy is planned for endotyping.
From the endoscopic office assessment, the next step is objective confirmation of sinonasal inflammation, which the AAO-HNS clinical practice guideline mandates before a diagnosis of chronic rhinosinusitis (CRS) is accepted [133]A1c[135]A1c. Three modalities, anterior rhinoscopy, nasal endoscopy, and computed tomography (CT), can satisfy this requirement, but the choice and sequence depend on clinical context and the need to define subtype [133]A1c[135]A1c.
Computed Tomography: The Gold-Standard Imaging Modality
Non-contrast, limited-slice coronal CT of the paranasal sinuses is the gold-standard imaging test for CRS. A Lund-Mackay score (LMS) of ≥4 (out of 24) is the most widely used radiographic threshold for disease, although a score of 0 essentially excludes CRS [208]B3b[217]B2b. The LMS correlates only weakly with patient-reported outcome measures (r = 0.434 with SNOT-22, P < .001) [193]B2a, meaning CT severity does not replace symptom assessment. CT is not indicated for uncomplicated acute rhinosinusitis [171]A1c.
In CRS with (CRSwNP), CT opacification of the olfactory cleft (OC) shows a moderate correlation with olfactory dysfunction (r = -0.464, P < .001), but in CRS without polyps (CRSsNP) only the total LMS, not OC opacification, correlates with smell loss [217]B2b. Ethmomaxillary sinus pneumatization, a common variant (prevalence 11.9%), is associated with higher ipsilateral CRS rates (12.5% vs 9.3%, P < .05) [228]C4.
A systematic review of diagnostic accuracy found that CT has sensitivity 0.90 but specificity only 0.50 against histopathology as reference standard [168]C4; false positives occur because CT cannot distinguish inflammation from mucosal thickening of other causes. Cone-beam CT offers lower radiation exposure but lacks soft-tissue characterization [206]B2a. Magnetic resonance imaging (MRI) is reserved for suspected fungal balls, complications (orbital/intracranial extension), or unilateral disease; MRI has moderate sensitivity (0.71) and high specificity (0.88) versus CT [168]C4[206]B2a.
Nasal Endoscopy as a Diagnostic Adjunct
Nasal endoscopy, performed in the office with a rigid or flexible scope, directly visualizes the middle meatus, sphenoethmoidal recess, and olfactory cleft. It has high sensitivity (0.87) but moderate specificity (0.63) against CT [168]C4. Endoscopic findings, polyps, purulent discharge, edema, or crusting, satisfy the objective-confirmation criterion [133]A1c[135]A1c. The Lund-Kennedy endoscopic score is the standard grading system and correlates with CT severity [77]C4.
Biopsy and Histology
Tissue biopsy is required for definitive subtyping in eosinophilic CRS (ECRS) and for diagnosing allergic fungal rhinosinusitis (AFRS) or respiratory epithelial adenomatoid hamartoma (REAH). The gold-standard histologic criterion for ECRS is ≥70 eosinophils per high-power field (HPF) on sinus mucosal biopsy [221]B3b[222]B3b. Preoperative systemic corticosteroids significantly reduce tissue eosinophil count (mean difference -36.57 cells/HPF; 95% CI -43.94 to -29.20) [224]B2a; therefore, if biopsy is planned for endotyping, clinicians should either withhold systemic steroids or obtain the biopsy before steroid initiation [224]B2a.
AFRS is defined by eosinophilic mucin containing fungal elements, type I hypersensitivity to fungi, and characteristic CT findings (heterogeneous opacification, bone erosion) [197]B3b[219]B3b. REAH appears as a widened olfactory cleft (≥10 mm on CT) and is often bilateral; it is misdiagnosed as inflammatory polyp in up to 50% of cases [154]C4[195]B2a.
Optical coherence tomography (OCT) of excised tissue is an emerging technique that can identify ECRS with a cutoff of 45 globules (sensitivity 100%, specificity 87.5%) compared to histology [215]C4.
Laboratory Studies
| Test | Finding | Utility |
|---|---|---|
| Blood eosinophil count | ≥0.16 × 10⁹/L or ≥2.05% | Predicts ECRS (sensitivity 84.9%, specificity 84.4%) [230]C4 |
| Serum total IgE | Elevated | Supports AFRS or type 2 phenotype [219]B3b |
| Serum 25-hydroxyvitamin D | <61.8 nmol/L | Independent risk factor for ECRSwNP (OR 3.074, P = 0.04) [229]B3b |
| Fractional exhaled nitric oxide (FeNO) | Pooled mean difference 32.21 ppb higher in ECRS vs non-ECRS | Noninvasive diagnostic tool for ECRS (diagnostic odds ratio 8.78) [207]B3a |
| Periostin (serum) | Elevated | Correlates with eosinophilic inflammation and CT severity; adds to eosinophil count [34]A1a |
| c-ANCA (PR3) | Positive | Screens for granulomatosis with polyangiitis (GPA) when nasal crusting, septal perforation, or saddle-nose deformity present [156]C4 |
| CFTR mutation analysis | Pathogenic variants | Indicated when CRS is accompanied by , bronchiectasis, or recurrent pancreatitis, especially in children [66]D5[194]B2a |
| Nasal nitric oxide (nNO) | Low | Screening test for primary ciliary dyskinesia (PCD) [151]D5 |
Diagnostic Algorithm
Step 1, Confirm the clinical diagnosis by documenting sinonasal inflammation on nasal endoscopy or CT. If both are unavailable, anterior rhinoscopy may suffice [133]A1c[135]A1c.
Step 2, Classify by phenotype: are nasal polyps present? This determines the subsequent workup [214]B3b.
Step 3, If CRSwNP, assess for eosinophilic endotype using blood eosinophil count, total IgE, and FeNO. If tissue is available, count eosinophils per HPF [221]B3b[230]C4.
Step 4, If asymmetric or unilateral disease, obtain MRI to exclude fungal ball, neoplasm, or REAH [206]B2a.
Step 5, If concerning features (nasal crusting, saddle-nose, epistaxis, orbital signs), obtain c-ANCA and consider biopsy for GPA [156]C4.
Step 6, In children or adults with recurrent pneumonia, situs inversus, or infertility, test for PCD (nNO, high-speed video microscopy, genetics) [151]D5 or CF (sweat chloride, CFTR genetics) [194]B2a.
Pearl: The Lund-Mackay CT score is the gold-standard imaging measure, but it correlates only weakly with symptoms; never rely on CT alone to diagnose CRS, the clinical history and endoscopic findings must align [193]B2a.
Controversies and Guideline Disagreement
| Question | AAO-HNS Position | EPOS Position | Strength | Implication |
|---|---|---|---|---|
| Required imaging for diagnosis | CT is one option for objective confirmation; not mandatory if endoscopy is diagnostic [133]A1c | CT is recommended for all suspected CRS to confirm extent and anatomy | Moderate | In practice, many clinicians obtain CT before surgery, but AAO-HNS does not require it [135]A1c |
| Biopsy for eosinophilic endotyping | Not routinely recommended before surgery; can be obtained at time of ESS [134]A1c | Recommended for research and endotype-guided therapy | Low | Preoperative biopsy may be deferred unless corticosteroid use will confound histology [224]B2a |
Severity, Staging and Risk Stratification
- ▸The Lund-Mackay CT score correlates only moderately with patient-reported symptoms (r = 0.434) and should not be used alone to guide treatment decisions.
- ▸The Modified Lund-Kennedy endoscopic score (excluding scarring and crusting) is more reliable and clinically relevant than the original Lund-Kennedy score.
- ▸Polyp recurrence after ESS is common (35% at 6 months), with prior surgery and worse preoperative polyposis as the strongest predictors.
Following diagnostic workup, the next step is to grade disease severity using standardized systems that guide treatment intensity, predict prognosis, and enable objective monitoring of therapeutic response. No single system captures all dimensions of CRS, so a combination of radiographic, endoscopic, and patient-reported measures is recommended.
Radiographic Staging: The Lund-Mackay System
The Lund-Mackay (LM) score (range 0-24) remains the most widely used CT staging tool, quantifying opacification of each sinus (0-2 per sinus) plus the ostiomeatal complex (0 or 2 per side). Despite its ubiquity, the correlation between LM score and patient-reported symptom severity is only moderate (SNOT-22: r = 0.434, P < 0.001) [193]B2a, and meta-regression found no significant association between LM and several other PROMs [193]B2a. This weak radiologic-symptom link means CT scores alone should not drive treatment escalation. The Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS) score evaluates the extent of prior surgery but also shows no linear relationship with quality of life [253]C4. Experimental three-dimensional volumetric scoring (Chicago MLM) correlates modestly with symptoms (p = 0.037) and quality of life (p = 0.007), particularly for ethmoid and sphenoid inflammation [248]C4.
Endoscopic Grading
The Lund-Kennedy (LK) endoscopic score grades polyps, edema, discharge, scarring, and crusting. A Modified Lund-Kennedy (MLK) score that excludes scarring and crusting demonstrates superior inter-rater and test-retest reliability and is the only system that correlates with the symptom subscore of the SNOT-22 in both unoperated and postoperative patients [160]B2b. The Meltzer endoscopic grading (0-3) is used for polyp severity. In the LIBERTY NP trials, the Nasal Polyp Score (NPS) (0-4 per nostril) served as a coprimary endpoint, with a mean difference versus placebo of -2.07 with tezepelumab [143]A1b and -3.1 with dupilumab at 24 weeks [233]A1b.
Patient-Reported Outcome Measures
The SNOT-22 (0-110) is the most commonly used disease-specific quality-of-life instrument; a clinically meaningful change is generally accepted as ≥8.9 points [232]B2b. The Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS) assess complementary domains: RSDI captures emotional impact, while CSS focuses on medication use and symptoms [237]D5.
Disease Control Criteria (EPOS 2020)
The European Position Paper on Rhinosinusitis and 2020 defines uncontrolled CRS as meeting at least three of the following in the prior month: (1) nasal blockage, rhinorrhea, facial pain, smell loss, or sleep disturbance; (2) use of rescue medications in the last 6 months; (3) presence of diseased mucosa on endoscopy [254]B3b. In a prospective cohort, 40% of CRS patients met uncontrolled criteria; these patients had significantly higher nasal mucus eosinophil-derived neurotoxin (EDN) levels (P = 0.010), blood eosinophil percentage (P = 0.015), and SNOT-22 scores (P < 0.001) [254]B3b. Mucus EDN level was an independent predictor of uncontrolled disease (OR 1.323, P = 0.004) [254]B3b.
Risk Stratification
| Factor | Impact on CRS Severity | Evidence |
|---|---|---|
| Asthma | Significant risk factor for uncontrolled status and eosinophilic CRS (ECRS) [242]B3b | OR for ECRS: not reported; uncontrolled rate higher in NP+AS (p < 0.05) [242]B3b |
| OSA | Higher odds of ESS (OR 1.91), antibiotic use (OR 1.90), and steroid use (OR 2.23) [238]B3b | Propensity-matched cohort: P < 0.0001 |
| Obesity | RR 1.23 for new-onset CRS at 1 year [12]B3b; aRR 1.44 for new-onset asthma in CRS patients [249]B3b | TriNetX cohort, 1:1 matching |
| Blood eosinophils | Cutoff >0.16 × 10⁹/L (sensitivity 84.9%, specificity 84.4%) for diagnosing ECRS [230]C4 | ROC AUC 0.873 |
| TAS2R38 polymorphisms | Associated with poorer outcomes after ESS [44]A1a | Meta-analysis of 4 trials |
| Cystic fibrosis carriers | Increased risk of CRS, more severe disease, higher antibiotic use [250]B3b | Population-based cohort |
Prognosis
Polyp recurrence after ESS is common: 35% at 6 months, 38% at 12 months, and 40% at 18 months [121]B2b. Worse preoperative polyposis severity (OR 1.4) and prior ESS (OR 2.6) are independent predictors of recurrence [121]B2b. Smoking cessation is associated with gradual improvement over 10-20 years to reach nonsmoker-level symptom scores [240]C4.
Controversies and Guideline Disagreement
| Question | Position A | Position B | Strength | Implication |
|---|---|---|---|---|
| Should CT scores drive treatment decisions? | CT scores correlate poorly with symptoms, so should not be used alone [193]B2a | Some guidelines include LM score as a criterion for biologic therapy [30]D5 | Moderate | Treatment decisions should incorporate CT, endoscopy, and PROMs |
These staging systems stratify patients into risk categories that inform the need for escalation to acute interventions or surgical planning, which are discussed in the following sections.
Pearl: The Modified Lund-Kennedy endoscopic score (excluding scarring and crusting) has the highest reliability and correlation with patient-reported outcomes, making it the preferred tool for serial clinical assessment [160]B2b.
Acute and Emergency Management
- ▸Acute exacerbations of CRS (AECRS) are common and typically managed with watchful waiting, intranasal corticosteroids, and saline irrigation; antibiotics are reserved for moderate-severe episodes or when bacterial infection is suspected.
- ▸Orbital and intracranial complications (Pott's puffy tumor, orbital abscess, meningitis) require immediate contrast-enhanced CT and empiric broad-spectrum antibiotics (cephalosporin + metronidazole + nafcillin) with urgent surgical drainage in most cases.
- ▸Bacterial isolates change over time in recurrent AECRS; culture-directed therapy is recommended for patients not responding to empiric antibiotics.
Severity staging guides the triage of acute exacerbations of chronic rhinosinusitis (AECRS) and its potentially life-threatening complications. The immediate priority is to identify patients with orbital, intracranial, or frontal bone involvement who require urgent surgical drainage and intravenous .
Step 1: Recognize Emergency Presentations
AECRS is defined as a transient worsening of sinonasal symptoms that return to baseline, but patients often describe "flare" or "sinus infection" and report associated poor sleep, fatigue, and malaise [26]C4. The most common pathogens during exacerbations are Staphylococcus aureus (MSSA 22.5%, coagulase-negative staphylococci 24.3%) and (11.9%) [126]B2a (2a).
Three complications demand immediate recognition:
- Orbital complications (periorbital , subperiosteal abscess, orbital abscess, cavernous sinus thrombosis): present with proptosis, ophthalmoplegia, vision loss, or chemosis.
- Pott's puffy tumor: a subperiosteal abscess of the frontal bone presenting with forehead swelling (74.7%), frontal headache (67%), and fever (59.3%) [279]C4 (4). Intracranial involvement occurs in 38.1% of adult cases [279]C4.
- Intracranial extension (meningitis, epidural abscess, subdural empyema, ): suspected with altered mental status, focal neurologic deficits, or seizure.
Step 2: Initial Assessment and Imaging
For any patient with suspected complicated AECRS, obtain contrast-enhanced CT of the sinuses and brain (or MRI for intracranial evaluation). The AAO-HNS 2025 guideline emphasizes that radiographic imaging is indicated when a complication or alternative diagnosis is suspected [135]A1c.
Step 3: Antibiotic and Surgical of Suppurative Complications
Empiric antibiotics must cover Streptococcus spp. (19.3% of Pott's puffy cases) and Staphylococcus spp. (16.6%) [279]C4. The most common empiric regimen reported is a combination of cephalosporin, , and nafcillin [279]C4 (4). Antibiotic duration averages 61 days for Pott's puffy tumor [279]C4.
Surgical intervention is required in 87.3% of Pott's puffy tumor cases [279]C4. Endoscopic drainage of the frontal sinus, often combined with external approach, is the standard. For orbital abscess, endoscopic or external drainage is guided by the location and size of the collection.
Step 4: Management of Uncomplicated AECRS
For patients without orbital or intracranial signs, the goal is to reduce symptom burden and prevent progression. The AAO-HNS 2025 guideline recommends watchful waiting (without antibiotics) as initial therapy for uncomplicated acute bacterial rhinosinusitis and by extension for AECRS without severe features [135]A1c. If antibiotics are prescribed, with or without clavulanate for 5 to 10 days remains first-line [133]A1c (1c).
Intranasal corticosteroids should be continued or initiated; they reduce inflammation and are supported by high-quality evidence [199]A1a (1a). Large-volume saline irrigation (≥150 mL) improves disease-specific quality of life (Rhinosinusitis Disability Index mean difference 13.5 points at 6 months, 95% CI 9.63 to 17.37) [201]A1a (1a).
Step 5: Referral and Escalation
If the patient worsens or fails to improve by 7 days after initial management, the AAO-HNS guideline mandates reassessment to confirm the diagnosis, exclude complications, and consider alternative therapy [133]A1c. Culture-directed antibiotics (endoscopic-guided middle meatal culture) are recommended for patients with recurrent AECRS or those not responding to empiric therapy, as bacterial isolates change in 68% of cases over time [282]C4 (4).
Drug and Management Summary Table
| Drug/Therapy | Indication | Dose/Duration | Key Evidence |
|---|---|---|---|
| Amoxicillin ± clavulanate | First-line antibiotics for uncomplicated AECRS | 500-875 mg PO BID × 5-10 days | AAO-HNS 2015 [133]A1c |
| Cephalosporin + metronidazole + nafcillin | Empiric for Pott's puffy tumor | Per local protocol; duration ~61 days | Case series [279]C4 |
| Intranasal corticosteroids | Maintenance and exacerbation reduction | Standard dose (e.g., fluticasone 2 sprays each nostril daily) | Cochrane 2016 [199]A1a |
| Large-volume saline irrigation | Symptom relief and QoL improvement | ≥150 mL per nostril once or twice daily | Cochrane 2016 [201]A1a |
What NOT to Do
- Do NOT use systemic antifungals or topical amphotericin B for uncomplicated AECRS; they show no benefit and carry hepatotoxicity risk [202]A1a (1a).
- Do NOT routinely prescribe antibiotics for every AECRS episode; watchful waiting is appropriate for mild exacerbations [135]A1c.
Controversies and Guideline Disagreement
No major guideline disagreements identified for the acute management of AECRS or its complications. The AAO-HNS 2025 update, ICAR-RS 2021, and the AAO-HNS 2015 guideline are consistent in recommending watchful waiting for uncomplicated episodes, amoxicillin as first-line antibiotic, and prompt imaging for suspected complications [135]A1c[133]A1c[19]A1c.
Pearl: For any CRS patient presenting with forehead swelling, fever, or orbital signs, obtain contrast-enhanced CT urgently, Pott's puffy tumor complicates sinusitis in 0.5-1% of cases, and intracranial involvement is present in nearly 40% of adult cases [279]C4.
| Clinical Scenario | First-Line Regimen | Duration | Evidence Level |
|---|---|---|---|
| Uncomplicated AECRS (mild-moderate) | Watchful waiting or amoxicillin ± clavulanate | 5-10 days | AAO-HNS 2015 [133]A1c (1c) |
| Uncomplicated AECRS (severe) | Amoxicillin-clavulanate 875/125 mg PO BID | 5-10 days | AAO-HNS 2015 [133]A1c (1c) |
| Pott's puffy tumor / orbital infection | Cephalosporin + metronidazole + nafcillin IV | ~61 days (mean) | Case series [279]C4 (4) |
| Recurrent AECRS with prior culture change | Culture-directed antibiotics after endoscopic culture | 7-14 days | Cohort [282]C4 (4) |
Medical versus Surgical Management (Definitive)
- ▸ESS is superior to continued medical therapy alone for refractory CRS, with large effect sizes on SNOT-22 (MACRO trial).
- ▸Biologics (dupilumab, tezepelumab, mepolizumab) are effective for severe CRSwNP; dupilumab shows the highest rank for NPS and SNOT-22 reduction.
- ▸Combining ESS with biologics or high-volume steroid irrigations improves outcomes over either alone, particularly in patients with large polyps.
Once acute exacerbations are controlled, the central decision in chronic rhinosinusitis (CRS) is whether to continue medical therapy or proceed with endoscopic sinus surgery (ESS). The AAO-HNS 2025 guideline emphasizes that surgery should be considered when patients have subtypes least likely to benefit from continued medical therapy alone, such as CRS with (CRSwNP), polyps with bony erosion, eosinophilic mucin, or fungal balls [134]A1c.
Step 1: Defining Medical Refractoriness and Surgical Candidacy
Before considering surgery, the surgeon must verify the diagnosis of CRS using established criteria and assess candidacy based on symptoms, disease characteristics, quality of life, and prior therapy [134]A1c. The guideline recommends against requiring a predefined, one-size-fits-all regimen or duration of medical therapy as a prerequisite to surgery [134]A1c. Patients with CRSwNP, prior ESS, and worse preoperative polyp severity are at higher risk for recurrence after surgery [121]B2b.
Step 2: Medical Management Options and Evidence
remain first-line. High-volume steroid nasal irrigations (e.g., budesonide 0.5 mg/2 mL added to 240 mL saline twice daily) are more effective than sprays, especially post-surgery, without significant hypothalamic-pituitary-adrenal axis suppression [292]D5[324]D5. A Cochrane review found topical corticosteroids improve symptom scores (SMD -0.46, 95% CI -0.65 to -0.27) and reduce polyp size (RR 2.09, 95% CI 1.65-2.64) [302]A1a. Saline irrigation alone improves disease-specific quality of life (MD 13.5 points on RSDI at 6 months) [201]A1a.
Biologics are indicated for severe, uncontrolled CRSwNP despite intranasal corticosteroids and prior surgery or systemic corticosteroid use [30]D5. A network meta-analysis of 19 studies ranked dupilumab highest for reducing nasal polyp score (MD -1.85, 95%), SNOT-22 (MD -12.56, 95%), and nasal congestion (MD -0.84, 95%) [291]A1a. Tezepelumab showed comparable efficacy to dupilumab at 52 weeks for NPS and NCS, with a lower surgery rate (0.5% vs 22.1%; HR 0.02, 95% CI 0.00-0.09) [143]A1b[308]A1a. Mepolizumab 100 mg subcutaneously every 4 weeks improved SNOT-22 by a mean of -35.3 points at 12 months in a real-world cohort [330]B2b. Depemokimab, dosed twice yearly, reduced NPS (integrated treatment difference -0.7, 95% CI -0.9 to -0.4) and NCS (-0.24, 95%) [294]A1b. Stapokibart, an anti-IL-4Rα antibody, improved multiple SNOT-22 domains at 24 weeks [337]A1b.
Macrolide (e.g., 250 mg twice daily for 2 weeks then once daily for 10 weeks) showed no significant benefit over placebo for SNOT-22 or VAS scores in the MACRO trial, though they improved nasal endoscopy scores (SMD -0.32, 95% CI -0.62 to -0.03) [92]A1a[295]A1b. Oral corticosteroids as adjunct therapy reduce polyp size but confer no additional benefit over placebo after ESS in CRS without polyps [205]A1a[140]A1b. Topical antibiotics are not recommended routinely; mupirocin irrigations may be considered for S. aureus infections [288]D5. Antifungals show no benefit over placebo [202]A1a.
Step 3: Surgical Management Options and Evidence
ESS improves disease-specific quality of life (SNOT-22) with large effect sizes (Cohen's d > 1.0) [314]B2b. At 24 weeks, ESS demonstrated significantly greater SNOT-22 improvements than omalizumab and comparable improvements to dupilumab [162]B2b. Polyp recurrence after ESS is common: 35% at 6 months, 40% at 18 months [121]B2b. Revision surgery rates vary by surgeon (mean 10.6%, range 2.4%-28.6%) [313]B2b. The Completion of Surgery Index (CoSI) helps identify patients likely to benefit from revision: those with CoSI < 70 improved by 28.1 points on SNOT-22 vs 14.1 points for CoSI ≥ 70 [218]B3b. Draf IIb frontal sinusotomy has lower restenosis (0.8% vs 12%) and revision rates (2% vs 10%) than Draf III [327]B2a.
Step 4: Comparative Effectiveness: Medical vs Surgical
The MACRO trial (N=514) found ESS plus intranasal medication superior to placebo plus intranasal medication at 6 months (SNOT-22 difference -8.9, 98.33%), while clarithromycin did not differ from placebo [295]A1b. Combining ESS with biologics (mepolizumab) improved SNOT-22 more than mepolizumab alone in patients with large polyps (NPS 6-8) [290]A1b. Perioperative dupilumab (14 weeks) improved long-term olfactory outcomes: 33.3% anosmia at 12 months vs 50% with placebo [104]A1b.
What NOT to Do
- Do not prescribe antibiotics for CRS without significant purulent discharge [134]A1c.
- Do not use oral corticosteroids routinely after ESS in CRS without polyps [140]A1b.
- Do not use topical or systemic antifungals for CRS [202]A1a.
- Do not require a predefined duration of medical therapy before considering surgery [134]A1c.
Controversies and Guideline Disagreement
| Question | Position A | Position B | Strength | Implication |
|---|---|---|---|---|
| Prior surgery required for biologics? | EPOS 2020, prior surgery is recommended but not mandatory | AAO-HNS 2025, prior surgery is not strictly required; candidacy based on symptoms and disease characteristics | Moderate [30]D5[134]A1c | Biologics may be initiated without prior ESS in selected patients, but most guidelines still recommend prior surgery. |
| Role of macrolides in CRS | MACRO trial, no benefit over placebo for SNOT-22 | Cochrane review, limited evidence; may improve endoscopy scores | Moderate [295]A1b[203]A1a | Macrolides are not recommended as first-line; consider only in select non-type 2 CRS. |
Pearl: For CRSwNP, ESS provides rapid and sustained improvement in quality of life and polyp reduction, but recurrence is common; combining surgery with biologics (dupilumab, mepolizumab) or high-volume steroid irrigations improves long-term outcomes, especially in patients with large polyps or type 2 inflammation [162]B2b[290]A1b[336]B2a.
| Biologic | NPS MD vs Placebo (95% CI) | SNOT-22 MD vs Placebo (95% CI) | NCS MD vs Placebo (95% CI) | SUCRA (NPS) |
|---|---|---|---|---|
| Dupilumab | -1.85 (-2.47 to -1.24) | -12.56 (-22.49 to -2.63) | -0.84 (-1.08 to -0.59) | 0.92 |
| Omalizumab | -1.30 (-1.90 to -0.70) | Not significant | -0.51 (-0.83 to -0.19) | , |
| Mepolizumab | -1.48 (-2.22 to -0.74) | Not significant | Not significant | , |
| Benralizumab | -0.84 (-1.66 to -0.03) | Not significant | Not significant | , |
| Tezepelumab (52 wk) | Comparable to dupilumab | Comparable to dupilumab | Comparable to dupilumab | , |
Data from [291]A1a and [308]A1a. MD = mean difference; NPS = nasal polyp score; NCS = nasal congestion score; SUCRA = surface under the cumulative ranking curve.
| Drug | Starting Dose | Target/Max Dose | Renal Adjustment | Hepatic Adjustment | Key Monitoring |
|---|---|---|---|---|---|
| Budesonide (high-volume irrigation) | 0.5 mg/2 mL added to 240 mL saline BID | Same | None | None | IOP, HPA axis (long-term) |
| Dupilumab | 300 mg SC every 2 weeks | Same | None | None | Eosinophil count, injection site reactions |
| Mepolizumab | 100 mg SC every 4 weeks | Same | None | None | Eosinophil count, hypersensitivity |
| Tezepelumab | 210 mg SC every 4 weeks | Same | None | None | Injection site reactions |
| Depemokimab | 100 mg SC every 26 weeks | Same | None | None | Eosinophil count |
| Clarithromycin (macrolide) | 250 mg PO BID for 2 weeks, then 250 mg daily for 10 weeks | Same | Reduce dose if CrCl <30 | Caution in hepatic impairment | QT interval, GI side effects |
Doses from [label] and pivotal trials [235]A1b[143]A1b[294]A1b[295]A1b.
History and Evolution of Treatment
- ▸Antifungal therapy and prolonged macrolide antibiotics have been abandoned after RCTs showed no benefit over placebo for CRS.
- ▸Biologics (dupilumab, mepolizumab, tezepelumab, depemokimab) represent a paradigm shift for severe CRSwNP, supported by multiple phase 3 trials demonstrating improvements in polyp size, symptoms, and quality of life.
- ▸The MACRO trial established endoscopic sinus surgery as superior to continued medical therapy with clarithromycin for patients with persistent symptoms, challenging the routine use of long-term antibiotics.
The evidence base that now guides the choice between medical and surgical therapy was built over decades, with several once-standard approaches abandoned after rigorous trials failed to confirm benefit.
The Era of Antimicrobial Therapy (and Its Decline)
The fungal hypothesis of CRS gained traction in the late 1990s, leading to widespread use of topical and systemic antifungals. A Cochrane meta-analysis of 6 RCTs (380 participants) found no statistically significant benefit for any outcome; symptom scores actually favored placebo, and adverse events were significantly higher in the antifungal group [307]A1a. This effectively ended the routine use of antifungals for CRS. Long-term macrolide therapy (e.g., ) was advocated for its anti-inflammatory properties. The MACRO trial (n=514) compared endoscopic sinus surgery (ESS), clarithromycin 250 mg twice daily for 2 weeks then once daily for 10 weeks, and placebo, all with intranasal medication. At 6 months, SNOT-22 scores were significantly lower in the surgery group compared to placebo, but clarithromycin was no better than placebo [295]A1b. This trial clarified that for patients remaining symptomatic after appropriate medical therapy, surgery offers superior benefit over continued .
The Rise of Topical and Systemic Corticosteroids
Saline irrigation became a mainstay after a trial showed irrigation superior to spray (SNOT-20 improvement 16.2 vs 8.8 at 4 weeks) [340]A1a. Adding budesonide to saline irrigation provided additional benefit: SNOT-22 improvement 20.7 vs 13.6 points, with 79% vs 59% achieving a clinically meaningful reduction [232]B2b. Budesonide irrigation also showed benefit in surgically naive patients (SNOT-22 mean difference 18.1 points) [365]A1b. However, the routine use of postoperative oral corticosteroids was challenged by a double-blind RCT of taper vs placebo after ESS in CRS without polyps, which found no difference in SNOT-22 or Lund-Kennedy scores up to 6 months, with worse psychological dysfunction in the prednisone group [140]A1b.
The Biologic Revolution
The landmark SINUS-24 and SINUS-52 trials established dupilumab 300 mg every 2 weeks as effective for severe CRSwNP, with significant improvements in nasal polyp score (NPS), nasal congestion, and Lund-Mackay CT scores [235]A1b. Subsequent phase 3 trials confirmed efficacy for mepolizumab 100 mg every 4 weeks (SYNAPSE) [344]A1b, tezepelumab 210 mg every 4 weeks (WAYPOINT) [143]A1b, and depemokimab 100 mg every 26 weeks (ANCHOR-1/2) [294]A1b. Real-world studies show dupilumab has faster onset but higher adverse event rates (45% vs 20% for mepolizumab) [369]B2b; ocular symptoms and arthralgia are most common with dupilumab [367]B2b. The combination of surgery with biologics may offer additional benefit for patients with large polyp scores (NPS 6-8) [290]A1b.
Lessons from Abandoned Therapies
Several therapies were abandoned after evidence failed to support them: systemic and topical antifungals [307]A1a, prolonged macrolide antibiotics without evidence [295]A1b, routine postoperative oral steroids in CRS without polyps [140]A1b, and one-size-fits-all preoperative medical therapy requirements [134]A1c. The current paradigm emphasizes phenotype- and endotype-directed therapy, with biologics reserved for severe type 2 disease and surgery offered when medical therapy fails.
Pearl: The MACRO trial's finding that clarithromycin was no better than placebo should prompt clinicians to reconsider prolonged antibiotic courses for CRS and instead prioritize surgery for appropriate candidates, especially those with persistent symptoms despite intranasal corticosteroids and saline irrigation [295]A1b.
| Therapy | Rationale (Historical) | Evidence Against | Current Status |
|---|---|---|---|
| Systemic/topical antifungals | Fungal hypothesis of CRS | Cochrane meta-analysis: no benefit, symptoms favored placebo [307]A1a | Not recommended |
| Prolonged macrolide antibiotics | Anti-inflammatory properties | MACRO trial: clarithromycin no better than placebo [295]A1b | Reserved for select cases (e.g., diffuse panbronchiolitis) |
| Routine postoperative oral steroids (CRSsNP) | Reduce inflammation | RCT: no benefit in SNOT-22 or endoscopy, worse psychological scores [140]A1b | Not recommended for CRS without polyps |
| One-size-fits-all preoperative medical therapy | Ensure maximal medical therapy before surgery | AAO-HNS guideline: should not require predefined regimen [134]A1c | Individualized approach |
Surgical Technique, Approaches and Perioperative Care
- ▸Extended ESS (LOEM 2-4) is associated with fewer revisions, lower recurrence, and greater symptom improvement than limited surgery [13].
- ▸Perioperative dupilumab preserves olfaction longer after ESS, and mepolizumab combined with FESS improves outcomes in patients with large polyps [104, 290].
- ▸Intraoperative PRP application accelerates epithelialization and reduces 1-year polyp recurrence after FESS for CRSwNP [119].
Building on the historical evolution of treatment, the current standard for medically refractory chronic rhinosinusitis (CRS) is endoscopic sinus surgery (ESS). Before considering surgery, the surgeon must verify the CRS diagnosis meets established criteria and assess candidacy based on symptoms, disease characteristics, quality of life, and prior therapy [134]A1c. No predefined, one-size-fits-all regimen of medical therapy (e.g., , steroids, antihistamines) should be required as a prerequisite for surgery [134]A1c. Patients who benefit most from surgery and are least likely to benefit from continued medical therapy alone include those with chronic rhinosinusitis with polyps (CRSwNP), polyps with bony erosion, eosinophilic mucin, or fungal balls [134]A1c.
Surgical Extent and Approach
The Lamella Ostium Extent Mucosa (LOEM) system provides a standardized framework to stratify ESS procedures. Extended procedures (LOEM 2-4) are associated with fewer revisions, lower recurrence rates, and greater SNOT-22 improvement compared with limited surgery (LOEM 1), with the most extensive approach (LOEM 4) showing the highest symptom improvement [13]B2a. The Completion of Surgery Index (CoSI), a 0-100 scale assessing surgical extent on pre- and postoperative CT, identifies patients likely to benefit from revision surgery: those with a preoperative CoSI <70 improve by a mean of 28.1 SNOT-22 points, versus 14.1 points for CoSI ≥70 (p = 0.029) [218]B3b.
Balloon sinus ostial dilation has no convincing evidence of superiority over conventional FESS for chronic frontal sinusitis at 12 months, with no difference in radiological resolution and a trend toward more synechiae in the balloon group [304]A1a.
Image-guided surgery (IGS) does not clearly improve surgical outcomes, completeness of dissection, or revision rates. Level 2A evidence suggests IGS may be associated with decreased major and total complications in certain cases, but bias and confounding limit this conclusion [310]D5.
Perioperative Medical
| Intervention | Evidence Summary | Key Recommendation |
|---|---|---|
| Antibiotics | AAO-HNS 2025: do not prescribe antibacterial therapy if significant purulent nasal discharge is absent [134]A1c. Long-term macrolide after ESS does not improve SNOT-22 or VAS but may improve nasal endoscopy score (SMD -0.32; 95% CI -0.62 to -0.03) [92]A1a. | Use only with documented purulence. Macrolide may be considered for endoscopic benefit. |
| Oral corticosteroids | In CRS without polyps, taper after ESS confers no benefit over placebo in SNOT-22 or Lund-Kennedy scores up to 6 months; worse psychological dysfunction scores were noted [140]A1b. In CRSwNP, high exposure (>90 days/year or >1.0 g cumulative prednisolone-equivalent) is associated with increased risk of avascular bone necrosis, osteoporosis, pneumonia, and a 23% higher overall adverse event risk (aOR 1.23; 95% CI 1.11-1.36) [387]B3b. | Avoid routine postoperative oral steroids in CRS without polyps. Minimize cumulative dose in CRSwNP. |
| Biologics as adjuncts | Perioperative dupilumab (14 weeks, starting 4 weeks pre-ESS) is associated with better olfactory preservation at 12 months (33.3% anosmia vs 50.0% placebo) and persistent serum IgE lowering [104]A1b. Mepolizumab 100 mg SC every 4 weeks plus FESS yields significantly greater SNOT-22 improvement in patients with large polyps (NPS 6-8) compared to mepolizumab alone (p < 0.05) [290]A1b. Tezepelumab 210 mg SC every 4 weeks reduces the need for NP surgery (0.5% vs 22.1% placebo; HR 0.02; 95% CI 0.00-0.09) and systemic corticosteroid use (5.2% vs 18.3%; HR 0.12; 95% CI 0.04-0.27) [143]A1b. | Consider perioperative biologic for severe CRSwNP with type 2 inflammation, especially when revision risk is high. |
Perioperative Care and Wound Healing
Nasal irrigation: Large-volume saline irrigation improves disease-specific quality of life (RSDI MD 13.5 points at 6 months; 95% CI 9.63-17.37) [201]A1a. Nonmedicated control substances (saline irrigation, nasal spray diluents) are associated with a mean SNOT-22 reduction of -8.81 (95% CI -12.60 to -5.03) [287]C4. Budesonide-added irrigations may outperform saline alone, but with significant heterogeneity [385]A1a.
Nasal packing: Absorbable and nonabsorbable packs show no significant difference in postoperative synechia (OR 0.33; 95% CI 0.04-2.78) [293]A1a. Absorbable materials (e.g., chitosan gel, fibrin glue) may improve hemostasis and reduce bleeding on removal, but superiority is not established [297]D5.
Platelet-rich plasma (PRP): Local application of autologous PRP to the ethmoid cavity and middle meatus after FESS for CRSwNP accelerates epithelialization (3.4 vs 5.1 weeks; p < 0.001), reduces postoperative debridements (1.5 vs 2.8; p < 0.001), and lowers 1-year polyp recurrence (8.3% vs 23.3%;) [119]B2b.
Controlled hypotension: Protocols targeting MAP 50-70 mmHg using dexmedetomidine, propofol, and remifentanil improve surgical field visibility. However, intraoperative cerebral desaturation has been observed, and most studies lack long-term neurological follow-up [277]D5.
Patient-Specific Considerations
Smoking: Cigarette smoking is associated with a 1.35-fold higher odds of CRS but does not negatively impact post-FESS quality of life, olfactory function, or endoscopy scores [96]A1a. Passive smoke exposure is also strongly correlated with CRS prevalence [49]A1a.
Advanced age: Patients of advanced age (≥65 years) experience less SNOT-22 improvement after ESS (SMD -0.36; 95% CI -0.61 to -0.10) but have lower recurrence (12%) and revision (3%) rates, a 50% risk reduction (RR 0.50; 95% CI 0.33-0.75). Age alone should not preclude surgery [383]B2a.
Olfaction: ESS improves subjective and objective olfaction, especially in patients with nasal polyposis or preoperative dysfunction (40-item Smell Identification Test improvement: 7.87, for polyp patients) [285]C4. Postoperative olfactory training combined with glucocorticoids reduces olfactory fluctuations in eosinophilic CRSwNP [103]A1b.
Sleep quality: ESS improves sleep quality, with large effects on Epworth Sleepiness Scale (SMD -0.94) and Pittsburgh Sleep Quality Index (SMD -0.80) [286]C4.
Pearl: In CRSwNP, maximize surgical extent (LOEM 3-4) to reduce revision rates, but avoid routine postoperative oral corticosteroids unless purulent discharge is present; consider perioperative biologic therapy for patients with high polyp burden or prior revision surgery.
| Intervention | Evidence Summary | Key Recommendation |
|---|---|---|
| Antibiotics | AAO-HNS 2025: do not prescribe if no purulent discharge [134]A1c. Macrolide improves NES but not SNOT-22 [92]A1a. | Use only with documented purulence. Macrolide may be considered for endoscopic benefit. |
| Oral corticosteroids | No benefit in CRS without polyps [140]A1b; high cumulative dose in CRSwNP increases adverse events (aOR 1.23) [387]B3b. | Avoid routine use; minimize cumulative dose. |
| Biologics as adjuncts | Perioperative dupilumab improves olfaction [104]A1b; mepolizumab + FESS better for large polyps [290]A1b; tezepelumab reduces need for surgery (HR 0.02) [143]A1b. | Consider for severe CRSwNP with type 2 inflammation. |
Complications
- ▸Major complications after ESS occur in 0.36% of primary cases and 0.46% of revision cases, with CSF leak, orbital injury, and hemorrhage being the most common [412][416].
- ▸Real-world dupilumab use shows a 13% discontinuation rate due to adverse events, with ocular complaints most frequent [367].
- ▸CRS independently increases the risk of chronic periodontitis (HR 1.59) and carries a high burden of comorbid depression and anxiety, particularly in empty nose syndrome [394][107].
Surgical technique and perioperative care directly influence complication rates, which range from minor self-limited events to rare but sight- or life-threatening injuries. Major complications after primary functional endoscopic sinus surgery (FESS) occur in 0.36% of cases (95% CI 0.32-0.40%), with a similar rate of 0.46% in revision procedures [412]B2b. A 25-year single-surgeon experience of 3402 patients reported an overall complication rate of 0.031 per patient, most commonly hemorrhage (n=41), orbital injury (n=29), and cerebrospinal fluid (CSF) leak (n=19) [413]C4.
Surgical Complications
A TriNetX analysis of 127,333 ESS procedures found a CSF leak rate of 0.28%, meningitis rate of 0.24%, orbital complication rate of 2.09% (including retrobulbar hematoma 0.10%, extraocular muscle injury 0.40%, and postoperative blindness or low vision 0.30%), and hemorrhage requiring intervention in 2.27% [416]B2b. Risk factors include revision surgery, , extensive disease, powered instrumentation, and age >40 years [412]B2b[413]C4. Middle turbinate resection reduces the risk of adhesions (OR 0.22) and lateralization (OR 0.17) but increases bleeding risk (OR 2.42) compared to preservation [399]B2a. Absorbable packing lowers postoperative synechia rates (OR 0.33) and bleeding compared to nonabsorbable materials [293]A1a. Steroid-releasing sinus implants reduce postoperative interventions by 35% and lysis of adhesions by 51% [400]A1a.
Medical Therapy Complications
Oral corticosteroids carry risks of mood disturbances, insomnia, and disturbance; short-term use (≤21 days) is recommended only for CRSwNP and allergic fungal sinusitis [204]A1a[392]B2a. are safe but exhalation delivery system with fluticasone (EDS-FLU) increases epistaxis (OR 5.80) [417]A1a. Dupilumab in real-world use: ocular adverse events are most common (15/115 patients), followed by injection site reactions (10), musculoskeletal complaints (9), and non-injection site skin reactions (8); 13% of patients discontinued due to an adverse event [367]B2b. Female sex is associated with higher risk of adverse events and discontinuation [367]B2b.
Disease-Related Complications
CRS independently increases the risk of chronic periodontitis (HR 1.59) [394]B2b. <i> Staphylococcus aureus </i> biofilms are associated with persistent postoperative symptoms, ongoing mucosal inflammation, and recurrent infections [398]B2b. Empty nose syndrome carries a high prevalence of depression (76.6%) and anxiety (77.0%) [107]A1a. Granulomatosis with polyangiitis may first present with nasal crusting, septal perforation, and saddle-nose deformity, often misdiagnosed as CRS [156]C4. Primary ciliary dyskinesia and cystic fibrosis are associated with recalcitrant CRS and require multidisciplinary [151]D5[8]A1c. Uncontrolled CRS is predicted by tissue eosinophil ratio >0.206, blood eosinophil ratio >0.025, and Lund-Mackay CT score ≥15 [411]C4.
Complication Table
| Complication | Frequency | Prevention | Management |
|---|---|---|---|
| CSF leak | 0.28% [416]B2b | Image guidance, careful dissection at skull base | Endoscopic repair, lumbar drain, |
| Orbital injury | 2.09% (retrobulbar hematoma 0.10%) [416]B2b | Avoid instrumentation lateral to uncinate process; pre-op CT review | Immediate ophthalmology consult, lateral canthotomy if hematoma |
| Hemorrhage (requiring intervention) | 2.27% [416]B2b | Preoperative control of , topical vasoconstrictors, absorbable packing | Nasal packing, cautery, embolization if refractory |
| Meningitis | 0.24% [416]B2b | Recognize and repair intraoperative CSF leak | Intravenous antibiotics, neurosurgical consultation |
| Synechiae | 4.6-8.0% with absorbable packing [293]A1a | Middle turbinate preservation or careful resection, steroid implants | Endoscopic lysis |
| Postoperative infection | 12% with Chitogel vs 52% control [396]A1b | Chitogel packing, saline irrigations | Culture-directed antibiotics |
Pain Management
Postoperative pain after ESS is mild. Acetaminophen 650 mg is first-line ; ibuprofen 600 mg is effective second-line, with most patients requiring no opioids [141]A1b. Mean opioid consumption is 35.2 MME (32% use none) [393]B2b. Preoperative gabapentin 600 mg does not reduce pain or opioid use [408]B2b. Sphenopalatine ganglion and anterior ethmoid nerve block with 0.5% bupivacaine significantly reduces VAS pain scores up to 6 hours postoperatively [410]A1b.
Pearl: Complication rates after ESS are low (<0.5% major), but risk factors, revision surgery, polyposis, powered instrumentation, warrant preoperative counseling and intraoperative caution [412]B2b[413]C4.
Prognosis and Natural History
- ▸Only 35-40% of patients achieve well-controlled disease after treatment, highlighting the need for ongoing management.
- ▸Polyp recurrence after ESS is common (35-40% by 18 months), with prior surgery and worse preoperative polyposis as key risk factors.
- ▸Biologics (especially dupilumab) achieve high remission rates (77%) and dramatically reduce the need for surgery and systemic corticosteroids.
Complications shape the natural history of CRS, but the disease trajectory itself is marked by high recurrence and substantial symptom burden even with optimal . Without treatment, only 8% of patients with CRS are well controlled [425]B2a. After medical or surgical therapy, approximately 35-40% achieve well-controlled disease, underscoring the chronic, relapsing nature of the condition [425]B2a.
Recurrence After Surgery
Polyp recurrence after endoscopic sinus surgery (ESS) is common: 35% at 6 months, 38% at 12 months, and 40% at 18 months [121]B2b. Risk factors include prior ESS (odds ratio [OR] 2.6) and worse preoperative polyp severity (OR 1.4, 95% CI 1.1-1.8) [121]B2b. Revision surgery rates average 15% overall; independent predictors are higher Lund-Mackay score, peripheral eosinophilia, and comorbid asthma or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease [332]B3b.
Medical and Biologic Outcomes
Intranasal corticosteroids reduce polyp size (mean improvement 0.43-0.63 points) and improve symptoms (risk ratio 1.71 for symptom improvement) [302]A1a[422]B2a. Budesonide added to saline irrigation yields a clinically meaningful 7-point greater SNOT-22 improvement than saline alone [232]B2b. Among biologics, dupilumab achieves disease remission (sustained control for ≥12 months) in 77% of patients [169]C4 and reduces the need for rescue surgery or systemic corticosteroids by 73% (7.89 to 2.14 events per patient-year) [316]B2b. In the phase 3 NAVIGATOR trial, tezepelumab reduced the need for nasal polyp surgery to 0.5% versus 22.1% with placebo (hazard ratio 0.02, 95% CI 0.00-0.09) [143]A1b. Mepolizumab provides sustained benefits for at least 24 weeks after discontinuation [344]A1b. Network meta-analyses rank dupilumab and tezepelumab as the most effective for nasal polyp score, nasal congestion, and SNOT-22 [291]A1a[429]A1a.
Functional and Quality-of-Life Outcomes
ESS improves SNOT-22 scores by a mean 23.0 points [421]B2a. Olfactory function improves significantly after surgery, especially in patients with polyps or preoperative dysfunction [285]C4. Biologics further enhance smell recovery; dupilumab and tezepelumab produce the largest psychophysical olfactory improvements (standardized mean difference 1.53 and 1.25, respectively) [427]B2a. Advanced-age patients experience less symptom improvement but have lower recurrence and revision rates (3% vs younger counterparts) [383]B2a.
Mental Health and Disease Burden
CRS is bidirectionally associated with anxiety and depression. Patients with CRS have a 2.79-fold increased risk of developing anxiety and 1.40-fold increased risk of depression (95% CI 1.27-1.55) [113]B2b. Effective treatment of CRS, medical or surgical, improves depression-specific outcomes, with 65.9% of patients who screened positive for depression at baseline no longer meeting criteria after treatment [158]B2b.
Predictors of Poor Prognosis
Key predictors of worse outcomes include prior ESS, worse preoperative polyp severity [121]B2b, comorbid asthma [242]B3b, higher Lund-Mackay score and peripheral eosinophilia [332]B3b, active smoking [96]A1a, and longer follow-up duration [421]B2a. In children, higher baseline SN-5 scores (>3.6) and detection of ILC-2 cells in nasal mucosa predict disease persistence at 5 years (OR 3.41) [375]B2b.
Pearl: Counsel patients that only 35-40% achieve well-controlled CRS after treatment, and that polyp recurrence after ESS is 35-40% within 18 months, prior surgery doubles the risk, but biologics can dramatically alter this trajectory (77% remission with dupilumab, NNT not calculable from reported data).
Special Populations
- ▸Pediatric CRS is frequently eosinophilic and often requires revision surgery; sinus balloon dilation is effective for medically refractory cases.
- ▸In pregnancy, intranasal corticosteroids are the safest option; systemic corticosteroids and surgery should be avoided.
- ▸CFTR modulator therapy (elexacaftor-tezacaftor-ivacaftor) is the cornerstone of CRS management in cystic fibrosis, with documented improvement in CT scores and clinical outcomes.
The prognosis of CRS varies widely across patient subgroups, and the preceding section highlights the natural history in the general population. In certain hosts, children, pregnant women, the elderly, and immunocompromised individuals, the disease behaves differently, and standard diagnostic and therapeutic algorithms require adjustment.
Pediatrics
Pediatric CRS (PCRS) is common and often underdiagnosed. In a cohort of 94 children undergoing endoscopic sinus surgery (ESS), eosinophilic CRS was the most frequent primary phenotype (20.2%), followed by allergic fungal rhinosinusitis (10.6%) and central compartment atopic disease (2.1%); cystic fibrosis (CF) was the most common secondary cause (13.8%), and over one-third could not be phenotyped [21]C4. Chronic adenoiditis can mimic PCRS [66]D5. Among children aged 4-8 years, CRS persisted at 5 years in 35%; a baseline SN-5 score >3.6 increased the risk (OR 3.41), and ILC-2 cells in nasal mucosa were predictive [375]B2b.
Diagnosis relies on nasal endoscopy and CT, with an emphasis on evaluating for immune deficiency and [66]D5. For medically refractory disease, sinus balloon catheter dilation (SBCD) in children aged 7-12 years significantly improved SN-5 and VAS scores at 1 year compared to controls [315]B3b. Biologic therapy for pediatric CRSwNP lacks robust trial data; however, dupilumab, omalizumab, and mepolizumab are FDA-approved for other atopic conditions in children, and a compassionate-use trial for dupilumab in pediatric is ongoing [431]B2a. Eosinophilic PCRS is most likely to require revision surgery [21]C4.
Pregnancy and Lactation
No dedicated studies on CRS during pregnancy were identified in the reviewed literature. In general, intranasal corticosteroids are considered safe owing to minimal systemic absorption, but specific safety data are absent. Systemic corticosteroids should be avoided if possible, and elective sinus surgery deferred until postpartum. For lactation, topical therapy remains the preferred route. Female sex is associated with higher odds of CRSsNP (OR 1.44 for age <60 years), but this reflects general sex differences rather than pregnancy-specific risks [114]C4.
Elderly
In women aged ≥55 years, hormone replacement therapy (HRT) was associated with lower odds of undergoing ESS (OR 0.28, 95% CI 0.25-0.32) but higher antibiotic use [321]B2b. Dupilumab-treated patients aged ≥50 years with CRSwNP had increased odds of arthritis-related adverse events (OR 1.81, p<0.001) compared with those treated for asthma or atopic dermatitis [436]C4. Comorbidities such as obstructive sleep apnea (OSA) are common in older CRS patients and are associated with higher rates of ESS (OR 1.91), antibiotic use (OR 1.90), and oral steroid use (OR 2.23) [238]B3b. Treatment modifications include adjusting for renal function, drug interactions, and fall risk; no age-specific dosing changes for standard CRS medications are established from the current evidence.
Immunocompromised (Cystic Fibrosis and Other)
Cystic fibrosis (CF) is the best-characterized immunocompromised population. CRS occurs in nearly all CF patients, is often refractory to standard therapy, and has high recurrence rates [331]D5. CFTR modulator therapy with elexacaftor-tezacaftor-ivacaftor (ETI) improved sinonasal disease: after 1 year, Lund-Mackay scores decreased from 5.8 to 3.3, and Sheikh-Lind scores from 3.8 to 2.2; pulmonary function and body mass index also improved, and oropharyngeal cultures showed reduced Pseudomonas and Staphylococcus aureus [210]B2b. Endoscopic scores similarly improved with triple therapy [155]B2a. No randomized controlled trials have evaluated medical interventions specifically for CF-CRS [434]A1a. Surgery data are limited; one small trial (n=28) found uncertain benefit of adding ESS to nasal irrigation [303]A1a. Extensive surgical approaches may improve long-term outcomes [331]D5.
For other immunocompromised states (e.g., primary immune deficiency, post-transplant), the literature is sparse. Low threshold for CT imaging and culture-directed therapy is recommended, along with multidisciplinary input from immunology [66]D5.
Pearl: In pediatric CRS, a baseline SN-5 score >3.6 predicts disease persistence, while in cystic fibrosis, CFTR modulator therapy (ETI) is the first-line treatment that improves both sinonasal and pulmonary outcomes.
Prevention, Screening and Surveillance
- ▸COVID-19 vaccination reduces incident CRS risk (HR 0.799), while infection increases it (HR 1.744); counsel vaccination for all CRS patients.
- ▸PPSV23 vaccination in patients with pneumococcal antibody deficiency (75.8% of CRS) significantly reduces antibiotic and steroid prescriptions and disease encounters.
- ▸Screen for OSA using the Sleep-SNOT (≥17.5) in CRS patients to identify those at high perioperative risk.
Having addressed special populations, attention turns to prevention, an underutilized opportunity to modify disease course. Unlike many chronic conditions, CRS has identifiable modifiable risk factors that can be targeted for primary prevention, and established screening tools that can identify high-risk subgroups before complications arise.
Primary Prevention
Avoidance of environmental triggers is the cornerstone. Smoking and secondhand smoke (SHS) are established risk factors, yet only 27% of CRS patients recall being asked about SHS exposure by their physician, and only 23% receive advice to avoid it [441]B3b. Brief physician inquiry increases cessation success; otolaryngologists should routinely screen for SHS and counsel avoidance. Mendelian randomization evidence causally links sedentary time, major depressive disorder, anxiety, PTSD, GERD, and rheumatoid arthritis to increased CRS risk [448]B2a. Conversely, coffee intake, higher apolipoprotein A1, and well-being are protective [448]B2a. Weight , mental health support, and treatment of comorbid GERD may reduce incident CRS, though interventional trials are lacking.
infection increases the risk of subsequent CRS diagnosis (HR 1.744) [449]B2b. The risk is highest during Omicron-dominant periods (RR 2.10) and is not modified by prior vaccination [437]B2b. In contrast, COVID-19 vaccination itself lowers the risk of CRS (HR 0.799) [449]B2b. Thus, vaccination against SARS-CoV-2 serves as a primary prevention strategy for CRS.
Secondary Prevention
Once CRS is established, preventing exacerbations and disease progression involves optimizing medical therapy. Long-term topical intranasal budesonide delivered via mucosal atomization device (MAD) is effective but carries a risk of adrenal suppression (3% incidence) and elevated intraocular pressure (6% incidence) [443]B2c. Surveillance with cosyntropin stimulation testing and tonometry should be considered periodically in patients using high-dose or chronic topical steroids, especially when combined with oral or inhaled corticosteroids (rate of hypocortisolemia 40% to 50% in users of concurrent steroids) [439]B2b.
Screening
Comorbid obstructive sleep apnea (OSA) affects approximately 20% of CRS patients and increases perioperative risk. The Sleep subdomain of the SNOT-22 (Sleep-SNOT) is a pragmatic screening tool: a score of ≥17.5 has a sensitivity of 68.9% and specificity of 55.7% for OSA detection [438]B3b. A positive screen should prompt formal sleep study referral.
Pneumococcal antibody deficiency is common in CRS (75.8%) and recurrent acute rhinosinusitis (74.8%) [442]B2b. Screening for nonprotective Streptococcus pneumoniae titers followed by PPSV23 vaccination reduces health-care utilization: a decrease in CRS diagnosis encounters (p < 0.0001), antibiotic prescriptions (p = 0.002), and corticosteroid prescriptions (p = 0.04) over 2 years post-vaccination [442]B2b.
Vaccine-Related Considerations
PPSV23 is indicated for patients aged 18-65 with CRS or RARS who have deficient antibody titers; 89% of CRS patients develop protective responses [442]B2b. COVID-19 vaccination is recommended for all CRS patients, as it reduces incident CRS risk [449]B2b. Rare cases of new-onset eosinophilic granulomatosis with polyangiitis (EGPA) have been reported within 14 days of mRNA-1273 vaccination, but the incidence lies within the expected background rate of 1:1,000,000, and the benefits of vaccination far outweigh this risk [447]C4.
Patient Education and Surveillance
Patients should be educated about the association between chronic sinonasal inflammation and the development of nasopharyngeal carcinoma and paranasal sinus malignancy (OR 3.51 and 5.30, respectively, for CRS; NNH = 311) [444]B3b. While routine surveillance imaging is not recommended, any new-onset unilateral symptoms, recurrent epistaxis, or cranial neuropathy warrants prompt evaluation. For patients with respiratory epithelial adenomatoid hamartoma (REAH), no recurrence was observed on follow-up endoscopy or imaging, suggesting that routine surveillance beyond clinical assessment is unnecessary [76]C4.
Pearl: Screen all CRS patients for pneumococcal antibody deficiency and offer PPSV23 if titers are nonprotective, this single intervention reduces health-care utilization by lowering antibiotic and steroid prescriptions [442]B2b.
| Risk Factor | Strength of Evidence | Actionable Intervention |
|---|---|---|
| Smoking / SHS | Established [441]B3b | Screen, counsel, refer for cessation |
| Sedentary time, obesity | Causal MR evidence [448]B2a | Weight management, physical activity |
| Depression, anxiety, PTSD | Causal MR evidence [448]B2a | Mental health screening and treatment |
| GERD | Causal MR evidence [448]B2a | PPI therapy, lifestyle modification |
| COVID-19 infection | HR 1.744 [449]B2b | Vaccination (protective) |
References
- [1]
Kaper NM, van der Heijden GJMG, Cuijpers SH et al.. “A comparison of international clinical practice guidelines on adult chronic rhinosinusitis shows considerable variability of recommendations for diagnosis and treatment.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2019). PMID: 31845037 ↗
L5GUIDELINECited in: Definition, Classification and Anatomic Localization, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment - [2]
Xie DX, Leland EM, Seal SM et al.. “A Systematic Review and Meta-Analysis of Taste Dysfunction in Chronic Rhinosinusitis.” The Laryngoscope (2020). PMID: 32609889 ↗
L2SR_OBSCited in: Definition, Classification and Anatomic Localization, Pathophysiology and Mechanism, Epidemiology, Etiology and Risk Factors, Clinical Presentation, History and Evolution of Treatment - [3]
Macdonald KI, Kilty SJ, van Walraven C. “Chronic rhinosinusitis identification in administrative databases and health surveys: A systematic review.” The Laryngoscope (2015). PMID: 26649650 ↗
L5SR_OBSCited in: Definition, Classification and Anatomic Localization, Epidemiology, Etiology and Risk Factors, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification, Surgical Technique, Approaches and Perioperative Care - [4]
Chester AC, Sindwani R. “Symptom outcomes in endoscopic sinus surgery: a systematic review of measurement methods.” The Laryngoscope (2007). PMID: 18322425 ↗
L5SR_OBSCited in: Definition, Classification and Anatomic Localization - [5]
Orlandi RR, Kingdom TT, Hwang PH et al.. “International Consensus Statement on Allergy and Rhinology: Rhinosinusitis.” International forum of allergy & rhinology (2016). PMID: 26889651 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization, Pathophysiology and Mechanism, Acute and Emergency Management, Surgical Technique, Approaches and Perioperative Care, Special Populations and Pregnancy - [6]
Orlandi RR, Kingdom TT, Hwang PH. “International Consensus Statement on Allergy and Rhinology: Rhinosinusitis Executive Summary.” International forum of allergy & rhinology (2016). PMID: 26878819 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization, Acute and Emergency Management - [7]
Sundaresan AS, Hirsch AG, Storm M et al.. “Occupational and environmental risk factors for chronic rhinosinusitis: a systematic review.” International forum of allergy & rhinology (2015). PMID: 26077513 ↗
L2SR_OBSCited in: Definition, Classification and Anatomic Localization, Pathophysiology and Mechanism, Epidemiology, Etiology and Risk Factors - [8]
Kimple AJ, Senior BA, Naureckas ET et al.. “Cystic Fibrosis Foundation otolaryngology care multidisciplinary consensus recommendations.” International forum of allergy & rhinology (2022). PMID: 35089650 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization, Complications - [9]
Samargandy S, Grose E, Chan Y et al.. “Medical and surgical treatment outcomes in patients with chronic rhinosinusitis and immunodeficiency: a systematic review.” International forum of allergy & rhinology (2020). PMID: 32668102 ↗
L2SR_OBSCited in: Definition, Classification and Anatomic Localization, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Acute and Emergency Management, Prognosis and Natural History - [10]
Mener DJ, Lin SY, Ishman SL et al.. “Treatment and outcomes of chronic rhinosinusitis in children with primary ciliary dyskinesia: where is the evidence? A qualitative systematic review.” International forum of allergy & rhinology (2013). PMID: 24124045 ↗
L4SR_OBSCited in: Definition, Classification and Anatomic Localization - [11]
Bhattacharyya N. “Clinical and symptom criteria for the accurate diagnosis of chronic rhinosinusitis.” The Laryngoscope (2006). PMID: 16826087 ↗
L2RCTCited in: Definition, Classification and Anatomic Localization - [12]
Hoying D, Kaelber DC, Chaaban MR. “Obesity is Associated with Increased Risk of New-Onset Chronic Rhinosinusitis: A United States Population-Based Cohort Study.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2024). PMID: 38482905 ↗
L3COHORTCited in: Definition, Classification and Anatomic Localization, Severity, Staging and Risk Stratification - [13]
González-García M, Prieto-Sánchez-de-Puerta L, Clari-Comes M et al.. “Surgical extent in chronic rhinosinusitis stratified by the LOEM system: systematic review and meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 41136575 ↗
L2SR_OBSCited in: Definition, Classification and Anatomic Localization, Severity, Staging and Risk Stratification, Surgical Technique, Approaches and Perioperative Care - [14]
Ali A, Fakunle DR, Yu V et al.. “Heterogeneity in the definition of chronic rhinosinusitis disease control: a systematic review of the scientific literature.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2023). PMID: 37378726 ↗
L5SR_OBSCited in: Definition, Classification and Anatomic Localization, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment - [15]
Maniaci A, Saibene AM, Calvo-Henriquez C et al.. “Is generative pre-trained transformer artificial intelligence (Chat-GPT) a reliable tool for guidelines synthesis? A preliminary evaluation for biologic CRSwNP therapy.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 38329526 ↗
L5SR_OBSCited in: Definition, Classification and Anatomic Localization - [16]
Calvo-Henriquez C, García-Lliberós A, Sánchez-Gómez S et al.. “Assessing the effect of absorbable steroid sinus implant: a state-of-the-art systematic review.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 38459984 ↗
L5SR_OBSCited in: Definition, Classification and Anatomic Localization - [17]
Grayson JW, Hopkins C, Mori E et al.. “Contemporary Classification of Chronic Rhinosinusitis Beyond Polyps vs No Polyps: A Review.” JAMA otolaryngology-- head & neck surgery (2020). PMID: 32644117 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification and Anatomic Localization, Pathophysiology and Mechanism, Severity, Staging and Risk Stratification, History and Evolution of Treatment - [18]
Welch KC, Stankiewicz JA. “A contemporary review of endoscopic sinus surgery: techniques, tools, and outcomes.” The Laryngoscope (2009). PMID: 19718751 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification and Anatomic Localization - [19]
Orlandi RR, Kingdom TT, Smith TL et al.. “International consensus statement on allergy and rhinology: rhinosinusitis 2021.” International forum of allergy & rhinology (2021). PMID: 33236525 ↗
L1REVIEW_NARRATIVECited in: Definition, Classification and Anatomic Localization, Acute and Emergency Management, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [20]
Craig JR, Poetker DM, Aksoy U et al.. “Diagnosing odontogenic sinusitis: An international multidisciplinary consensus statement.” International forum of allergy & rhinology (2021). PMID: 33583151 ↗
L1REVIEW_NARRATIVECited in: Definition, Classification and Anatomic Localization, Clinical Presentation, Surgical Technique, Approaches and Perioperative Care - [21]
Morgan E, Cunningham MJ, Adil EA. “Phenotyping and Endotyping Pediatric Chronic Rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2025). PMID: 40111215 ↗
L4OTHERCited in: Definition, Classification and Anatomic Localization, Pathophysiology and Mechanism, Severity, Staging and Risk Stratification, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Special Populations and Pregnancy - [22]
Brietzke SE, Shin JJ, Choi S et al.. “Clinical consensus statement: pediatric chronic rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2014). PMID: 25274375 ↗
L1OTHERCited in: Definition, Classification and Anatomic Localization, Medical versus Surgical Management (Definitive) - [23]
Lu N, Kacin AJ, Shaffer AD et al.. “Otorhinologic Disorders in 22q11.2 Deletion Syndrome.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 36950877 ↗
L4OTHERCited in: Definition, Classification and Anatomic Localization, Severity, Staging and Risk Stratification, Acute and Emergency Management, Medical versus Surgical Management (Definitive), Prognosis and Natural History - [24]
Smith WM, Davidson TM, Murphy C. “Regional variations in chronic rhinosinusitis, 2003-2006.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2009). PMID: 19716012 ↗
L2OTHERCited in: Definition, Classification and Anatomic Localization - [25]
Hoying D, Kaelber DC, Chaaban MR. “Assessing the Impact of GLP-1R Agonists in Post-sinus Surgery Management.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2025). PMID: 41353729 ↗
L3OTHERCited in: Definition, Classification and Anatomic Localization - [26]
Walker V, Trope M, Tichavakunda AA et al.. “Patient Perspectives on Acute Exacerbations of Chronic Rhinosinusitis: A Qualitative Study.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 36040819 ↗
L4OTHERCited in: Definition, Classification and Anatomic Localization, Acute and Emergency Management - [27]
McCoul ED, Todd CA, Riley CA. “Posterior Inferior Turbinate Hypertrophy (PITH).” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2018). PMID: 30296890 ↗
L4OTHERCited in: Definition, Classification and Anatomic Localization, Severity, Staging and Risk Stratification - [28]
Chong LY, Head K, Hopkins C et al.. “Different types of intranasal steroids for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2016). PMID: 27115215 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization, Diagnostic Imaging, Tissue Sampling and Workup, Acute and Emergency Management, Complications - [29]
Leung N, Mawby TA, Turner H et al.. “Osteitis and chronic rhinosinusitis: a review of the current literature.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2015). PMID: 26525884 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification and Anatomic Localization, Pathophysiology and Mechanism, Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification, Prognosis and Natural History - [30]
Rampi A, Vinciguerra A, Tanzini U et al.. “Comparison of guidelines for prescription and follow-up of biologics for chronic rhinosinusitis with nasal polyps.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 36098864 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification and Anatomic Localization, Severity, Staging and Risk Stratification, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History, Special Populations and Pregnancy - [31]
Alharbi T, Alsubaie N, Alroqi A. “An overview of switching biological therapies for chronic rhinosinusitis with nasal polyposis (CRSwNP).” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 40736678 ↗
L5REVIEW_NARRATIVECited in: Definition, Classification and Anatomic Localization, Special Populations and Pregnancy - [32]
Nie L, Xu C, Liu Y et al.. “The role of adjunctive therapies in the management of recurrent rhinosinusitis: a meta-analytical approach.” Frontiers in public health (2026). PMID: 42100506 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [33]
Demidova A, Kiknavelidze N, Purtskhvanidze K et al.. “'What' and 'How' to Measure in Allergy and Clinical Immunology: A Systematic Review of Core Outcome Sets and Outcome Harmonisation Processes.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (2026). PMID: 41974646 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization - [34]
Abdullah B, Mohamad S, Kamarudin IK et al.. “Defining the Role and Clinical Relevance of Periostin in Chronic Rhinosinusitis with or without Nasal Polyps: a Systematic Review and Meta-analysis.” Current allergy and asthma reports (2026). PMID: 41537926 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization, Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification - [35]
Xu Y, Quan H, Faris P et al.. “Prevalence and Incidence of Diagnosed Chronic Rhinosinusitis in Alberta, Canada.” JAMA otolaryngology-- head & neck surgery (2016). PMID: 27606773 ↗
L2OTHERCited in: Definition, Classification and Anatomic Localization, Epidemiology, Etiology and Risk Factors - [36]
Jitaroon K, Wangworawut Y, Ma Y et al.. “Evaluation of the Incidence of Other Cranial Neuropathies in Patients With Postviral Olfactory Loss.” JAMA otolaryngology-- head & neck surgery (2020). PMID: 32239202 ↗
L3OTHERCited in: Definition, Classification and Anatomic Localization, Epidemiology, Etiology and Risk Factors, Clinical Presentation, Severity, Staging and Risk Stratification, History and Evolution of Treatment - [37]
Chan DK, McNamara S, Park JS et al.. “Sinonasal Quality of Life in Children With Cystic Fibrosis.” JAMA otolaryngology-- head & neck surgery (2016). PMID: 27228505 ↗
L4OTHERCited in: Definition, Classification and Anatomic Localization, Clinical Presentation - [38]
Smith KA, Farrell NF, Romashko A et al.. “Evaluation of Practice Patterns for 6-Sinus Balloon Sinus Dilation.” JAMA otolaryngology-- head & neck surgery (2026). PMID: 41231509 ↗
L4OTHERCited in: Definition, Classification and Anatomic Localization, Acute and Emergency Management - [39]
Kasle DA, Torabi SJ, Narwani V et al.. “Medicare Reimbursement for Balloon Catheter Dilations Among Surgeons Performing High Volumes of the Procedures to Treat Chronic Rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2020). PMID: 31971549 ↗
L2OTHERCited in: Definition, Classification and Anatomic Localization - [40]
Rudmik L, Xu Y, Liu M et al.. “Utilization Patterns of Topical Intranasal Steroid Therapy for Chronic Rhinosinusitis: A Canadian Population-Based Analysis.” JAMA otolaryngology-- head & neck surgery (2016). PMID: 27560503 ↗
L2OTHERCited in: Definition, Classification and Anatomic Localization - [41]
Alt JA, Orlandi RR, Mace JC et al.. “Does Delaying Endoscopic Sinus Surgery Adversely Impact Quality-of-Life Outcomes?” The Laryngoscope (2018). PMID: 30208208 ↗
L2OTHERCited in: Definition, Classification and Anatomic Localization - [42]
Wu AW, Halawi AM, Illing EA et al.. “Postoperative Polyp Scale (POPS): Development of a New Sinonasal Polyp Grading Scale.” The Laryngoscope (2023). PMID: 36866689 ↗
L5OTHERCited in: Definition, Classification and Anatomic Localization - [43]
Lucidi D, Pipolo C, Pagella F et al.. “Surgical Adequacy in ESS for Primary Diffuse CRS: Expert Consensus Recommendations.” The Laryngoscope (2026). PMID: 41532608 ↗
L5OTHERCited in: Definition, Classification and Anatomic Localization - [44]
Ardalan A, Adl S, Moarefvand K et al.. “Personalizing sinus surgery: a systematic review and meta-analysis of clinical and genetic predictors of outcome in chronic rhinosinusitis.” Journal of the Korean Association of Oral and Maxillofacial Surgeons (2026). PMID: 42055777 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization, Severity, Staging and Risk Stratification - [45]
Al-Imam A, Al-Hadithi N, Michalak M. “Meta-analysis of concha bullosa anatomy with emphasis on Middle Eastern and Asian populations.” Folia morphologica (2026). PMID: 41994965 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization, Epidemiology, Etiology and Risk Factors - [46]
Lázaro-Sastre M, Moreno-Rodilla E, Martín-García C et al.. “A Systematic Review of the Specific Role of Biological Therapies in Aspirin-Exacerbated Respiratory Disease.” Journal of investigational allergology & clinical immunology (2026). PMID: 41556270 ↗
L1SR_OBSCited in: Definition, Classification and Anatomic Localization - [47]
Aidan G, Andrea K, Thomas G et al.. “Eosinophilic Oesophagitis Beyond the Oesophagus: High Prevalence of Chronic Rhinosinusitis-Type Symptoms and Their Impact on Symptom Severity in Swiss EoE Cohort Study Patients.” Alimentary pharmacology & therapeutics (2026). PMID: 42350932 ↗
L2COHORTCited in: Definition, Classification and Anatomic Localization, Epidemiology, Etiology and Risk Factors - [48]
Hoying D, Miller K, Tanzo J et al.. “Evaluating the Association of Obesity and Chronic Rhinosinusitis: A Systematic Review and Meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 38108590 ↗
L1SR_OBSCited in: Pathophysiology and Mechanism, Epidemiology, Etiology and Risk Factors, Clinical Presentation - [49]
Christensen DN, Franks ZG, McCrary HC et al.. “A Systematic Review of the Association between Cigarette Smoke Exposure and Chronic Rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2018). PMID: 29460678 ↗
L1SR_OBSCited in: Pathophysiology and Mechanism, Epidemiology, Etiology and Risk Factors, History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care - [50]
Iqbal IZ, Kao SS, Ooi EH. “The role of biologics in chronic rhinosinusitis: a systematic review.” International forum of allergy & rhinology (2019). PMID: 31869863 ↗
L1SR_OBSCited in: Pathophysiology and Mechanism - [51]
Basharat U, Aiche MM, Kim MM et al.. “Are rhinoviruses implicated in the pathogenesis of sinusitis and chronic rhinosinusitis exacerbations? A comprehensive review.” International forum of allergy & rhinology (2019). PMID: 31430424 ↗
L2SR_OBSCited in: Pathophysiology and Mechanism, Epidemiology, Etiology and Risk Factors - [52]
Danielides G, Lygeros S, Kanakis M et al.. “Periostin as a biomarker in chronic rhinosinusitis: A contemporary systematic review.” International forum of allergy & rhinology (2022). PMID: 35514144 ↗
L5SR_OBSCited in: Pathophysiology and Mechanism - [53]
Spielman DB, Beswick DM, Kimple AJ et al.. “The management of cystic fibrosis chronic rhinosinusitis: An evidenced-based review with recommendations.” International forum of allergy & rhinology (2022). PMID: 34933415 ↗
L5SR_OBSCited in: Pathophysiology and Mechanism, Clinical Presentation - [54]
Ou J, Wang J, Xu Y et al.. “Staphylococcus aureus superantigens are associated with chronic rhinosinusitis with nasal polyps: a meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2014). PMID: 24604680 ↗
L3SR_OBSCited in: Pathophysiology and Mechanism, Epidemiology, Etiology and Risk Factors - [55]
Timperley D, Schlosser RJ, Harvey RJ. “Chronic rhinosinusitis: an education and treatment model.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2010). PMID: 20970689 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [56]
Renteria AE, Mfuna Endam L, Desrosiers M. “Do Aging Factors Influence the Clinical Presentation and Management of Chronic Rhinosinusitis?” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2017). PMID: 28195747 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism, History and Evolution of Treatment - [57]
Behnke J, Dundervill C, Al-Asadi Z et al.. “Gender Differences in Adults With Chronic Rhinosinusitis: A Scoping Review.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2024). PMID: 38317564 ↗
L2REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [58]
Ramanathan M, Lane AP. “Innate immunity of the sinonasal cavity and its role in chronic rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2007). PMID: 17321858 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [59]
Jongbloed WM, Tessema B. “Egyptian Dynasties to Biologics: A Historical Review of Nasal Polyposis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2024). PMID: 38666767 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [60]
Lee JJW, Hamour AF, Wihlidal JGJ et al.. “Cannabinoids and the Endocannabinoid System in the Treatment of Chronic Rhinosinusitis.” The Laryngoscope (2025). PMID: 40260746 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism, Special Populations and Pregnancy - [61]
Gevaert P, Han JK, Smith SG et al.. “The roles of eosinophils and interleukin-5 in the pathophysiology of chronic rhinosinusitis with nasal polyps.” International forum of allergy & rhinology (2022). PMID: 35243803 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [62]
Roland LT, Damask C, Luong AU et al.. “Allergic Fungal Rhinosinusitis Diagnosis, Management, Associated Conditions, Pathophysiology, and Future Directions: Summary of a Multidisciplinary Workshop.” International forum of allergy & rhinology (2025). PMID: 40310935 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism, Prognosis and Natural History - [63]
Gong X, Fu Y, Zhou L et al.. “Decoding chronic rhinosinusitis: A metabolomics-based approach.” International forum of allergy & rhinology (2024). PMID: 38343156 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism, History and Evolution of Treatment - [64]
Workman AD, Parasher AK, Blasetti MT et al.. “Accuracy of Self-reported Diagnosis of Chronic Rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2018). PMID: 30396322 ↗
L2OTHERCited in: Pathophysiology and Mechanism, Diagnostic Imaging, Tissue Sampling and Workup - [65]
Reilly BK, Conley DB. “Bone chip-induced rhinosinusitis.” The Laryngoscope (2009). PMID: 19877189 ↗
L4CASE_REPORTCited in: Pathophysiology and Mechanism, Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [66]
Ramadan HH. “Pediatric chronic rhinosinusitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2023). PMID: 37899371 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism, Epidemiology, Etiology and Risk Factors, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Special Populations and Pregnancy - [67]
Yao Y, Xie S, Yang C et al.. “Biomarkers in the evaluation and management of chronic rhinosinusitis with nasal polyposis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2017). PMID: 28365802 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism, Medical versus Surgical Management (Definitive), Prognosis and Natural History - [68]
Wu D, Bleier BS, Wei Y. “Temporary olfactory improvement in chronic rhinosinusitis with nasal polyps after treatment.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2018). PMID: 30027441 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism, Clinical Presentation - [69]
Gelardi M, Giancaspro R, Cassano M. “Biofilm in sino-nasal infectious diseases: the role nasal cytology in the diagnostic work up and therapeutic implications.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 36376525 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [70]
Margulis I, Mohd Slim MA, Sommer EC et al.. “Geographic Disparities in Evidence Investigating the Use of Biologics in Chronic Rhinosinusitis.” Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale (2026). PMID: 41689786 ↗
L2SR_OBSCited in: Pathophysiology and Mechanism - [71]
Yang HH, O'Sharkey K, Paul K et al.. “Traffic and Industrial Pollutants and Chronic Rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2026). PMID: 42207538 ↗
L3OTHERCited in: Pathophysiology and Mechanism, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care - [72]
Aurora R, Chatterjee D, Hentzleman J et al.. “Contrasting the microbiomes from healthy volunteers and patients with chronic rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2013). PMID: 24177790 ↗
L3OTHERCited in: Pathophysiology and Mechanism - [73]
Hsieh JW, Daskalou D, Detroux V et al.. “Olfactory Fluctuation Revisited.” The Laryngoscope (2020). PMID: 32738075 ↗
L4OTHERCited in: Pathophysiology and Mechanism, Epidemiology, Etiology and Risk Factors, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment - [74]
Gozawa R, Imoto Y, Sonoda Y et al.. “Feasibility of Treating Eosinophilic Chronic Rhinosinusitis Using Short-Chain Fatty Acids.” The Laryngoscope (2025). PMID: 40641312 ↗
L5OTHERCited in: Pathophysiology and Mechanism, Prognosis and Natural History, Special Populations and Pregnancy - [75]
Alegre Edo B, Rojas-Lechuga MJ, Quer-Castells M et al.. “Quality of Life in Symptomatic Septal Perforation.” The Laryngoscope (2024). PMID: 38850257 ↗
L2OTHERCited in: Pathophysiology and Mechanism - [76]
Fischer JL, Oh E, Sajed DP et al.. “Respiratory Epithelial Adenomatoid Hamartoma Characteristics of Extra-Olfactory Cleft Disease.” The Laryngoscope (2025). PMID: 40855816 ↗
L4OTHERCited in: Pathophysiology and Mechanism, Audiologic, Vestibular and Endoscopic Assessment, Prevention, Screening and Surveillance - [77]
Abbas EE, Li C, Xie A et al.. “Distinct Clinical Pathology and Microbiota in Chronic Rhinosinusitis With Nasal Polyps Endotypes.” The Laryngoscope (2020). PMID: 32770821 ↗
L4OTHERCited in: Pathophysiology and Mechanism, Diagnostic Imaging, Tissue Sampling and Workup - [78]
Lee JT, Simpson CA, Yang HH et al.. “Fungal and Bacterial Microbiome in Sinus Mucosa of Patients with and without Chronic Rhinosinusitis.” The Laryngoscope (2023). PMID: 37606305 ↗
L3OTHERCited in: Pathophysiology and Mechanism - [79]
Alkholaiwi F, Zamil Alzamil L, Mohammed Alotaibi R et al.. “Navigating the orbital complications of endoscopic sinus surgery: a systematic review of 204,286 patients.” Frontiers in surgery (2026). PMID: 41815776 ↗
L5SR_OBSCited in: Pathophysiology and Mechanism, Acute and Emergency Management - [80]
Kumbul YÇ, Yasan H, Okur E et al.. “The role of raftlin in the pathogenesis of chronic rhinosinusitis with nasal polyps.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 35488906 ↗
L3OTHERCited in: Pathophysiology and Mechanism - [81]
Huang GJ, Liu HB. “Identification and validation of ferroptosis-related genes for chronic rhinosinusitis with nasal polyps.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 36255469 ↗
L5OTHERCited in: Pathophysiology and Mechanism - [82]
Zhang Z, Li G, Yu L et al.. “Causal relationships between potential risk factors and chronic rhinosinusitis: a bidirectional two-sample Mendelian randomization study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 36585990 ↗
L2OTHERCited in: Pathophysiology and Mechanism, Epidemiology, Etiology and Risk Factors - [83]
Kusunoki T, Joseph D, Ikeda K et al.. “Evaluating antioxidant treatment approaches for eosinophilic chronic sinusitis.” Frontiers in immunology (2026). PMID: 42396451 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [84]
Liu X, Hu J, Gan W et al.. “Programmed Cell Death in Chronic Rhinosinusitis.” Clinical and translational allergy (2026). PMID: 42230296 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [85]
Li DL, Li Y, Jiang YJ et al.. “The Mechanism of NLRP3 Inflammasome Activation and Its Roles in Chronic Rhinosinusitis.” World journal of otorhinolaryngology - head and neck surgery (2025). PMID: 42205417 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [86]
Pasupat D, Chaiyasate S, Thonusin C et al.. “Potential roles of microRNAs in chronic rhinosinusitis: from mechanistic insights to clinical studies.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026). PMID: 42086994 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [87]
Tan S, Lai J, Yu S. “Biofilm adaptation and mucosal immune dysregulation in recalcitrant chronic rhinosinusitis: from pathogenesis to a therapeutic roadmap.” Frontiers in immunology (2026). PMID: 42058217 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [88]
Pan M, Jia Z, Zhou M et al.. “The Application of Single-cell RNA Sequencing Technology in the Research of Sino-Nasal Diseases.” Clinical reviews in allergy & immunology (2026). PMID: 41849011 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism - [89]
Engeroff P, Gharailoo Z, Vogel M et al.. “A Case for Anti-IgE Vaccination.” Allergy (2026). PMID: 41814126 ↗
L5REVIEW_NARRATIVECited in: Pathophysiology and Mechanism, Prevention, Screening and Surveillance - [90]
Chen F, Liu L, Wang Y et al.. “Prevalence of Depression and Anxiety in Patients With Chronic Rhinosinusitis: A Systematic Review and Meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 35230890 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors - [91]
Heiland LD, Farmer HG, Nguyen SA et al.. “Headache and Facial Pain/Pressure in the Chronic Rhinosinusitis Population: A Systematic Review and Meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2024). PMID: 38895867 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup - [92]
Shu F, Li CX, Zhang F et al.. “Systematic Review and Meta-analysis: Macrolide in the Treatment of Chronic Rhinosinusitis After Endoscopic Sinus Surgery.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 37548067 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Special Populations and Pregnancy - [93]
Gutierrez JA, Durrant FG, Nguyen SA et al.. “Association between Social Determinants of Health and Allergic Fungal Rhinosinusitis: A Systematic Review and Meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 37293865 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors - [94]
Monos S, Yan F, McLean CC. “Predicting Adherence to Topical Medications in Chronic Rhinologic Disease: A Systematic Review.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2024). PMID: 38822756 ↗
L2SR_OBSCited in: Epidemiology, Etiology and Risk Factors - [95]
Kohli P, Naik AN, Harruff EE et al.. “The prevalence of olfactory dysfunction in chronic rhinosinusitis.” The Laryngoscope (2016). PMID: 27873345 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Clinical Presentation - [96]
Tan CJ, Leow BHW, Tan BKJ et al.. “Association Between Smoking and Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.” The Laryngoscope (2023). PMID: 38112394 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [97]
Xiao JB, Hsiao H, Khalil C et al.. “Rheumatic adverse events associated with biologic therapy for chronic rhinosinusitis: A systematic review and meta-analysis.” International forum of allergy & rhinology (2024). PMID: 39302201 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors - [98]
Niu X, Chen Y, Zhou T et al.. “Endoscopic vidian and vidian-branch neurectomy for refractory allergic rhinitis: A systematic review.” International forum of allergy & rhinology (2023). PMID: 37715589 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [99]
Aulakh A, Choudhary P, Sidhu G et al.. “The Risk of Rheumatic Disorders Among Patients With Rhinosinusitis: A Systematic Review and Meta-Analysis.” International forum of allergy & rhinology (2025). PMID: 40911435 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Acute and Emergency Management - [100]
Huang Z, Zhou B. “Clarithromycin for the treatment of adult chronic rhinosinusitis: a systematic review and meta-analysis.” International forum of allergy & rhinology (2019). PMID: 30629811 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Diagnostic Imaging, Tissue Sampling and Workup - [101]
Hashemian F, Ghorbanian MA, Hashemian F et al.. “Effect of Topical Furosemide on Rhinosinusal Polyposis Relapse After Endoscopic Sinus Surgery: A Randomized Clinical Trial.” JAMA otolaryngology-- head & neck surgery (2016). PMID: 27416546 ↗
L1RCTCited in: Epidemiology, Etiology and Risk Factors, Severity, Staging and Risk Stratification, Complications, Prognosis and Natural History - [102]
Jeon YJ, Joo YH, Cho HJ et al.. “Associations Between Chronic Rhinosinusitis and Cancers: A Nationwide Population-Based Cohort Study.” The Laryngoscope (2022). PMID: 35587128 ↗
L2COHORTCited in: Epidemiology, Etiology and Risk Factors - [103]
Zhang Z, Tu J, Tang B et al.. “Chronic Sinusitis With Nasal Polyps and Olfactory Dysfunction: Comparing Olfactory Training and Glucocorticoid Treatment.” The Laryngoscope (2025). PMID: 40265744 ↗
L1RCTCited in: Epidemiology, Etiology and Risk Factors, Clinical Presentation, History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History, Special Populations and Pregnancy - [104]
Pelletier A, Endam LM, Gonzalez E et al.. “Perioperative adjuvant therapy with short course of dupilumab with ESS for recurrent CRSwNP.” International forum of allergy & rhinology (2024). PMID: 39444257 ↗
L1RCTCited in: Epidemiology, Etiology and Risk Factors, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History, Special Populations and Pregnancy - [105]
Hirsch AG, Schwartz BS, Nordberg C et al.. “Risk of new-onset and prevalent disease in chronic rhinosinusitis: A prospective cohort study.” International forum of allergy & rhinology (2023). PMID: 36756720 ↗
L2COHORTCited in: Epidemiology, Etiology and Risk Factors - [106]
Cox DR, Ashby S, DeConde AS et al.. “Dyad of pain and depression in chronic rhinosinusitis.” International forum of allergy & rhinology (2015). PMID: 26954903 ↗
L2TRIAL_NONRANDOMCited in: Epidemiology, Etiology and Risk Factors - [107]
Shah AH, Chau IJ, Nguyen SA et al.. “Depression and anxiety in empty nose syndrome: A systematic review and Meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 40617870 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Complications - [108]
Lechien JR, Ragrag K, Kasongo J et al.. “Association between Helicobacter pylori, reflux and chronic rhinosinusitis: a systematic review.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 39893593 ↗
L3SR_OBSCited in: Epidemiology, Etiology and Risk Factors - [109]
. “Corrigendum.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2017). PMID: 28926718 ↗
L5OTHERCited in: Epidemiology, Etiology and Risk Factors, Audiologic, Vestibular and Endoscopic Assessment - [110]
Luo X, Lu H, Chen J et al.. “Effects of Environmental Factors on Incidence of Allergic Rhinitis and Chronic Rhinosinusitis: A Comparative Study.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2026). PMID: 41800620 ↗
L2OTHERCited in: Epidemiology, Etiology and Risk Factors - [111]
Lourijsen E, Avdeeva K, Gan KL et al.. “Oral and intranasal aspirin desensitisation for non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease.” The Cochrane database of systematic reviews (2025). PMID: 39775459 ↗
L1SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment - [112]
Peters AT, Rolland C, Lavoie L et al.. “The Burden of Chronic Rhinosinusitis Without Nasal Polyps: A Systematic Review of Epidemiological, Clinical, Humanistic, and Economic Evidence.” Advances in therapy (2026). PMID: 42060156 ↗
L2SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Severity, Staging and Risk Stratification - [113]
Khan NS, Gajula M, Goehring L et al.. “Chronic Rhinosinusitis and Mental Health.” JAMA otolaryngology-- head & neck surgery (2024). PMID: 39264594 ↗
L2OTHERCited in: Epidemiology, Etiology and Risk Factors, Prognosis and Natural History, Special Populations and Pregnancy - [114]
Chiu RG, Ahn A, Eldeirawi K et al.. “Biological Sex and Chronic Rhinosinusitis Diagnosis and Biomarkers.” JAMA otolaryngology-- head & neck surgery (2026). PMID: 41129161 ↗
L4OTHERCited in: Epidemiology, Etiology and Risk Factors, Special Populations and Pregnancy - [115]
Zalzal HG, Lawlor CM. “Down Syndrome for the Otolaryngologist: A Review.” JAMA otolaryngology-- head & neck surgery (2023). PMID: 36862403 ↗
L5REVIEW_NARRATIVECited in: Epidemiology, Etiology and Risk Factors, Clinical Presentation, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [116]
Kuo CL, Yen YC, Chang WP et al.. “Association Between Middle Ear Cholesteatoma and Chronic Rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2017). PMID: 28494066 ↗
L2OTHERCited in: Epidemiology, Etiology and Risk Factors, Prognosis and Natural History - [117]
Yang HH, Paul KC, Cockburn MG et al.. “Residential Proximity to a Commercial Pesticide Application Site and Risk of Chronic Rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2023). PMID: 37440215 ↗
L4OTHERCited in: Epidemiology, Etiology and Risk Factors, History and Evolution of Treatment - [118]
Kim JY, Ko I, Kim MS et al.. “Association of Chronic Rhinosinusitis With Depression and Anxiety in a Nationwide Insurance Population.” JAMA otolaryngology-- head & neck surgery (2019). PMID: 30730537 ↗
L2OTHERCited in: Epidemiology, Etiology and Risk Factors, Special Populations and Pregnancy - [119]
Su J, Bai Y, Wu G et al.. “Efficacy of Local Application of Platelet-Rich Plasma (PRP) on Mucosal Healing and Clinical Outcomes After Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps: A Retrospective Cohort Study.” American journal of rhinology & allergy (2026). PMID: 42175591 ↗
L2COHORTCited in: Epidemiology, Etiology and Risk Factors, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [120]
Homøe AS, Tidemandsen J, Aanæs K et al.. “Effect of Mepolizumab on Middle Ear Disease and Hearing Outcomes in CRSwNP.” The Laryngoscope (2026). PMID: 41631410 ↗
L1RCTCited in: Epidemiology, Etiology and Risk Factors, Audiologic, Vestibular and Endoscopic Assessment, History and Evolution of Treatment - [121]
DeConde AS, Mace JC, Levy JM et al.. “Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis.” The Laryngoscope (2016). PMID: 27859303 ↗
L2OTHERCited in: Epidemiology, Etiology and Risk Factors, Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Severity, Staging and Risk Stratification, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [122]
Orb Q, Curtin K, Oakley GM et al.. “Familial risk of pediatric chronic rhinosinusitis.” The Laryngoscope (2015). PMID: 26228920 ↗
L2OTHERCited in: Epidemiology, Etiology and Risk Factors, Severity, Staging and Risk Stratification - [123]
Masuda M, Ikeba H, Takeuchi M et al.. “Impact of smoking on sinus CT findings across subtypes of chronic rhinosinusitis: A retrospective study.” American journal of otolaryngology (2026). PMID: 41956016 ↗
L4COHORTCited in: Epidemiology, Etiology and Risk Factors, Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification - [124]
Akita T, Nishijima H, Sato T et al.. “Sinonasal disease in lung transplant recipients: A retrospective study at a single lung-transplant center in Japan.” Auris, nasus, larynx (2026). PMID: 41687133 ↗
L4COHORTCited in: Epidemiology, Etiology and Risk Factors, Clinical Presentation - [125]
Falcon RMG, Diarota MA, Gammad RIT et al.. “Prevalence of Central Compartment Atopic Disease (CCAD): a systematic review and meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026). PMID: 42215785 ↗
L2SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Prevention, Screening and Surveillance - [126]
Kim HO, Ha S, Shim JJ et al.. “A Systematic Review and Meta-Analysis of Bacterial Pathogen Prevalence in Acute and Chronic Rhinosinusitis: Implications for Empiric Antibiotic Therapy and Antimicrobial Stewardship.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 42214663 ↗
L2SR_OBSCited in: Epidemiology, Etiology and Risk Factors, Acute and Emergency Management - [127]
Chen G, Guo W, Liu S et al.. “Causal analysis between gastroesophageal reflux disease and chronic rhinosinusitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 38189968 ↗
L2OTHERCited in: Epidemiology, Etiology and Risk Factors - [128]
Seidel DU, Busenius J, Below M et al.. “Prescriptions of biologics in patients with chronic rhinosinusitis with nasal polyps in Germany (2019-2023).” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 41076463 ↗
L3OTHERCited in: Epidemiology, Etiology and Risk Factors - [129]
Clarhed UKE, Schiöler L, Torén K et al.. “BMI as a risk factor for the development of chronic rhinosinusitis: a prospective population-based study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 35305138 ↗
L2OTHERCited in: Epidemiology, Etiology and Risk Factors - [130]
Passali GC, Passali D, Cingi C et al.. “Smell impairment in patients with chronic rhinosinusitis: a real-life study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2021). PMID: 33942122 ↗
L4OTHERCited in: Epidemiology, Etiology and Risk Factors - [131]
Fukuda A, Morita S, Nakamaru Y et al.. “Differentiation Between Eosinophilic Otitis Media and Otitis Media Associated With Eosinophilic Granulomatosis With Polyangiitis.” Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2019). PMID: 31290803 ↗
L4OTHERCited in: Epidemiology, Etiology and Risk Factors, Diagnostic Imaging, Tissue Sampling and Workup, Special Populations and Pregnancy - [132]
Lourijsen E, Avdeeva K, Gan KL et al.. “Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery.” The Cochrane database of systematic reviews (2023). PMID: 36808096 ↗
L1REVIEW_NARRATIVECited in: Epidemiology, Etiology and Risk Factors - [133]
Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al.. “Clinical practice guideline (update): adult sinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2015). PMID: 25832968 ↗
L1GUIDELINECited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Acute and Emergency Management, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care - [134]
Shin JJ, Wilson M, McKenna M et al.. “Clinical Practice Guideline: Surgical Management of Chronic Rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2025). PMID: 40424072 ↗
L1GUIDELINECited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care - [135]
Payne SC, McKenna M, Buckley J et al.. “Executive Summary of the Clinical Practice Guideline on Adult Sinusitis Update.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2025). PMID: 40741969 ↗
L1GUIDELINECited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Acute and Emergency Management, Medical versus Surgical Management (Definitive), History and Evolution of Treatment - [136]
Meltzer EO, Hamilos DL, Hadley JA et al.. “Rhinosinusitis: Developing guidance for clinical trials.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2006). PMID: 17081855 ↗
L5GUIDELINECited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Severity, Staging and Risk Stratification, Acute and Emergency Management, History and Evolution of Treatment - [137]
Shin JJ, Wilson M, McKenna M et al.. “Executive Summary of the Clinical Practice Guideline on the Surgical Management of Chronic Rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2025). PMID: 40437675 ↗
L1GUIDELINECited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, History and Evolution of Treatment - [138]
Adelman J, McLean C, Shaigany K et al.. “The Role of Surgery in Management of Samter's Triad: A Systematic Review.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2016). PMID: 27071444 ↗
L2SR_OBSCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment - [139]
Bhandarkar ND, Sautter NB, Kennedy DW et al.. “Osteitis in chronic rhinosinusitis: a review of the literature.” International forum of allergy & rhinology (2012). PMID: 23258589 ↗
L2SR_OBSCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification - [140]
Chang MT, Noel J, Ayoub NF et al.. “Oral Corticosteroids Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis Without Nasal Polyposis: A Randomized Clinical Trial.” JAMA otolaryngology-- head & neck surgery (2021). PMID: 33662124 ↗
L1RCTCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Complications - [141]
Ayoub NF, Choby G, Turner JH et al.. “Assessment of Opioid Use and Analgesic Requirements After Endoscopic Sinus Surgery: A Randomized Clinical Trial.” JAMA otolaryngology-- head & neck surgery (2021). PMID: 34351376 ↗
L1RCTCited in: Clinical Presentation, Acute and Emergency Management, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Complications, Prognosis and Natural History - [142]
Tyler MA, Lam K, Ashoori F et al.. “Analgesic Effects of Intravenous Acetaminophen vs Placebo for Endoscopic Sinus Surgery and Postoperative Pain: A Randomized Clinical Trial.” JAMA otolaryngology-- head & neck surgery (2017). PMID: 28542675 ↗
L1RCTCited in: Clinical Presentation, History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Complications, Prognosis and Natural History - [143]
Lipworth BJ, Han JK, Desrosiers M et al.. “Tezepelumab in Adults with Severe Chronic Rhinosinusitis with Nasal Polyps.” The New England journal of medicine (2025). PMID: 40106374 ↗
L1RCTCited in: Clinical Presentation, Severity, Staging and Risk Stratification, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History, Special Populations and Pregnancy - [144]
Gomes SC, Delemarre T, Holtappels G et al.. “Olfaction in nasal polyp patients after Reboot surgery: an endotype-based prospective study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 36571613 ↗
L2COHORTCited in: Clinical Presentation - [145]
Wang T, Su J, Feng Y. “The effectiveness topical amphotericin B in the management of chronic rhinosinusitis: a meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2014). PMID: 25217082 ↗
L2SR_OBSCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment - [146]
Alt JA, Smith TL. “Chronic rhinosinusitis and sleep: a contemporary review.” International forum of allergy & rhinology (2013). PMID: 24039230 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation - [147]
Tyler MA, Lam K, Marino MJ et al.. “Revisiting the controversy: The role of fungi in chronic rhinosinusitis.” International forum of allergy & rhinology (2021). PMID: 34076362 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation - [148]
Rimmer J, Fokkens W, Chong LY et al.. “Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps.” The Cochrane database of systematic reviews (2014). PMID: 25437000 ↗
L1SR_OBSCited in: Clinical Presentation, Acute and Emergency Management, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [149]
Martinez-Devesa P, Patiar S. “WITHDRAWN: Oral steroids for nasal polyps.” The Cochrane database of systematic reviews (2016). PMID: 27111708 ↗
L1SR_OBSCited in: Clinical Presentation, History and Evolution of Treatment - [150]
Tzelnick S, Alkan U, Leshno M et al.. “Sinonasal debridement versus no debridement for the postoperative care of patients undergoing endoscopic sinus surgery.” The Cochrane database of systematic reviews (2018). PMID: 30407624 ↗
L1SR_OBSCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Severity, Staging and Risk Stratification, Acute and Emergency Management - [151]
Harman K, Horani A, Shoemark A. “The Diagnosis of Primary Ciliary Dyskinesia: Putting The European Respiratory/American Thoracic Guideline Into Practice.” Pediatric pulmonology (2026). PMID: 41889169 ↗
L5GUIDELINECited in: Clinical Presentation, Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification, History and Evolution of Treatment, Complications - [152]
Sakalar EG, Muluk NB, Kar M et al.. “Aspirin-exacerbated respiratory disease and current treatment modalities.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2016). PMID: 27538737 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation, Acute and Emergency Management, Medical versus Surgical Management (Definitive) - [153]
Klausner MS, Gianoli GJ, Johnson P et al.. “The challenge of diagnosing intracranial pressure elevations as an otolaryngologist.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 40155542 ↗
L5REVIEW_NARRATIVECited in: Clinical Presentation - [154]
Lam F, Chu AP, Wong FK et al.. “Clinical and Molecular Presentation of Respiratory Epithelial Adenomatoid Hamartoma: A Systematic Review.” American journal of rhinology & allergy (2026). PMID: 42024035 ↗
L4SR_OBSCited in: Clinical Presentation, Diagnostic Imaging, Tissue Sampling and Workup - [155]
Gallardo R, Silva BS, Salgado LS et al.. “Systematic Review of Nasal Endoscopy Scores in Cystic Fibrosis Patients Treated With Cystic Fibrosis Transmembrane Conductance Regulator Modulators.” Pediatric pulmonology (2026). PMID: 41919747 ↗
L2SR_OBSCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Special Populations and Pregnancy - [156]
Patil V, Auradkar A, Muniraju M et al.. “Otolaryngologic manifestations in granulomatosis with Polyangitis: A systematic review of clinical presentations and renal correlation.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026). PMID: 41622276 ↗
L4SR_OBSCited in: Clinical Presentation, Diagnostic Imaging, Tissue Sampling and Workup, Acute and Emergency Management, Complications - [157]
Zhang SK, Prince AA, Corrales CE et al.. “Concordance Between an Adaptive Sino-Nasal Outcome Test and Imaging Results in Chronic Rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2026). PMID: 42133355 ↗
L4OTHERCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Surgical Technique, Approaches and Perioperative Care, Special Populations and Pregnancy - [158]
Schlosser RJ, Hyer JM, Smith TL et al.. “Depression-Specific Outcomes After Treatment of Chronic Rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2016). PMID: 26967171 ↗
L2OTHERCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [159]
Schlosser RJ, Mulligan JK, Hyer JM et al.. “Mucous Cytokine Levels in Chronic Rhinosinusitis-Associated Olfactory Loss.” JAMA otolaryngology-- head & neck surgery (2016). PMID: 27228459 ↗
L4OTHERCited in: Clinical Presentation - [160]
Psaltis AJ, Li G, Vaezeafshar R et al.. “Modification of the Lund-Kennedy endoscopic scoring system improves its reliability and correlation with patient-reported outcome measures.” The Laryngoscope (2014). PMID: 24615873 ↗
L2OTHERCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Severity, Staging and Risk Stratification, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [161]
Liu CM, Fischer JL, Lee MJ et al.. “Olfaction, Eating Preference, and Quality of Life in Cystic Fibrosis Chronic Rhinosinusitis.” The Laryngoscope (2025). PMID: 40156369 ↗
L4OTHERCited in: Clinical Presentation - [162]
Miglani A, Soler ZM, Smith TL et al.. “A comparative analysis of endoscopic sinus surgery versus biologics for treatment of chronic rhinosinusitis with nasal polyposis.” International forum of allergy & rhinology (2022). PMID: 35980852 ↗
L2OTHERCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [163]
Craig JR, Dai X, Bellemore S et al.. “Inflammatory endotype of odontogenic sinusitis.” International forum of allergy & rhinology (2022). PMID: 36308740 ↗
L3OTHERCited in: Clinical Presentation, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [164]
Othieno F, Schlosser RJ, Rowan NR et al.. “Taste impairment in chronic rhinosinusitis.” International forum of allergy & rhinology (2018). PMID: 29569385 ↗
L4OTHERCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Medical versus Surgical Management (Definitive), History and Evolution of Treatment - [165]
Litsou E, Psychogios G, Saridi M et al.. “Ear, Nose, and Throat Manifestations in Inflammatory Bowel Diseases: A Systematic Review of the Clinical Spectrum.” Medicina (Kaunas, Lithuania) (2026). PMID: 42195197 ↗
L4SR_OBSCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Surgical Technique, Approaches and Perioperative Care, Complications - [166]
Guo B, Xiong P, Zhang Z et al.. “Predictors of the Efficacy of Focused Ultrasound for Moderate-to-Severe Persistent Allergic Rhinitis: A Retrospective Cohort Study.” Ultrasound in medicine & biology (2026). PMID: 42144291 ↗
L4COHORTCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Severity, Staging and Risk Stratification, Prognosis and Natural History - [167]
Movahedi Aliabadi M, Sharifi Sarasyabi M, Asoudeh R et al.. “Allergic fungal rhinosinusitis and its fungal species in Eastern Mediterranean: A systematic review.” Journal de mycologie medicale (2026). PMID: 42061107 ↗
L4SR_OBSCited in: Clinical Presentation - [168]
Lu Y, Gao X, Wang X et al.. “Diagnostic accuracy of nasal endoscopy, computed tomography and magnetic resonance imaging for chronic rhinosinusitis and sinonasal polyps: a systematic review and meta-analysis.” The Journal of laryngology and otology (2026). PMID: 41693180 ↗
L4SR_OBSCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup - [169]
Loperfido A, Cavaliere C, Ciofalo A et al.. “Remission in chronic rhinosinusitis with nasal polyps treated with biologics: a real-life experience.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 40759784 ↗
L4OTHERCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Medical versus Surgical Management (Definitive), Prognosis and Natural History, Special Populations and Pregnancy - [170]
Ryder CY, Zacharek MA, Welch CM. “Improvement of Suspected Eosinophilic Otitis Media with Targeted Biologic Therapy.” Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2023). PMID: 37026811 ↗
L4OTHERCited in: Clinical Presentation, Audiologic, Vestibular and Endoscopic Assessment, Special Populations and Pregnancy - [171]
Rosenfeld RM, Andes D, Bhattacharyya N et al.. “Clinical practice guideline: adult sinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2007). PMID: 17761281 ↗
L1GUIDELINECited in: Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup, Acute and Emergency Management - [172]
Shah GB, De Keyzer L, Russell JA et al.. “Treatment of chronic rhinosinusitis with dornase alfa in patients with cystic fibrosis: a systematic review.” International forum of allergy & rhinology (2018). PMID: 29323796 ↗
L2SR_OBSCited in: Audiologic, Vestibular and Endoscopic Assessment - [173]
Hur K, Liang J, Lin SY. “The role of secondhand smoke in sinusitis: a systematic review.” International forum of allergy & rhinology (2013). PMID: 24574074 ↗
L2SR_OBSCited in: Audiologic, Vestibular and Endoscopic Assessment - [174]
Li W, Lu H, Wang H et al.. “Efficacy and safety of steroid-impregnated implants following sinus surgery: A meta-analysis.” The Laryngoscope (2019). PMID: 31755990 ↗
L1SR_OBSCited in: Audiologic, Vestibular and Endoscopic Assessment - [175]
Albrecht T, Baumann I, Plinkert PK et al.. “Three-dimensional endoscopic visualization in functional endoscopic sinus surgery.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2016). PMID: 27094054 ↗
L2RCTCited in: Audiologic, Vestibular and Endoscopic Assessment, Medical versus Surgical Management (Definitive), History and Evolution of Treatment - [176]
Rudmik L, Soler ZM, Smith TL et al.. “Effect of Continued Medical Therapy on Productivity Costs for Refractory Chronic Rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2015). PMID: 26513715 ↗
L4OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment, Special Populations and Pregnancy - [177]
Ahn JC, Kim JW, Lee CH et al.. “Prevalence and Risk Factors of Chronic Rhinosinusitus, Allergic Rhinitis, and Nasal Septal Deviation: Results of the Korean National Health and Nutrition Survey 2008-2012.” JAMA otolaryngology-- head & neck surgery (2016). PMID: 26747377 ↗
L2OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment - [178]
Lima Luz-Matsumoto GR, Cabernite Marchetti E, Lobato Gregorio L et al.. “High-dose steroid nasal spray is better than nasal irrigation in nonoperated chronic rhinosinusitis: a randomized clinical trial.” Rhinology (2026). PMID: 41486776 ↗
L1RCTCited in: Audiologic, Vestibular and Endoscopic Assessment - [179]
De Corso E, Canonica GW, Heffler E et al.. “Dupilumab versus omalizumab in patients with chronic rhinosinusitis with nasal polyps and coexisting asthma (EVEREST): a multicentre, randomised, double-blind, head-to-head phase 4 trial.” The Lancet. Respiratory medicine (2025). PMID: 41033334 ↗
L1RCTCited in: Audiologic, Vestibular and Endoscopic Assessment - [180]
Othieno F, Schlosser RJ, Storck KA et al.. “Retronasal olfaction in chronic rhinosinusitis.” The Laryngoscope (2018). PMID: 29637564 ↗
L4OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [181]
Han JK. “Subclassification of chronic rhinosinusitis.” The Laryngoscope (2013). PMID: 23371324 ↗
L3OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup - [182]
Lim DJ, Bicknell BT, Rivers N et al.. “Safety and Pharmacokinetics of a Ciprofloxacin and Azithromycin Stent for Chronic Rhinosinusitis.” The Laryngoscope (2024). PMID: 38563347 ↗
L5OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup - [183]
Tomoum MO, Klattcromwell C, DelSignore A et al.. “Depression and anxiety in chronic rhinosinusitis.” International forum of allergy & rhinology (2015). PMID: 25952937 ↗
L4OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment - [184]
Han EJ, Liu CM, Fischer JL et al.. “Impact of sociodemographic status and sex on chronic rhinosinusitis and olfaction in people with cystic fibrosis.” International forum of allergy & rhinology (2024). PMID: 38967583 ↗
L4OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment - [185]
Czerny MS, Namin A, Gratton MA et al.. “Histopathological and clinical analysis of chronic rhinosinusitis by subtype.” International forum of allergy & rhinology (2014). PMID: 24574266 ↗
L4OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment - [186]
Lam M, Hull L, McLachlan R et al.. “Clinical severity and epithelial endotypes in chronic rhinosinusitis.” International forum of allergy & rhinology (2012). PMID: 23038685 ↗
L4OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment - [187]
Govoni M, Soncini A, Bardon ML et al.. “Dupilumab in chronic rhinosinusitis with nasal polyposis and concomitant cystic fibrosis: a real-life experience.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 39643811 ↗
L4CASE_REPORTCited in: Audiologic, Vestibular and Endoscopic Assessment - [188]
Clari-Comes M, Martin-Jimenez D, Moreno-Luna R et al.. “Treatment escalation and sustained disease control in chronic rhinosinusitis: a retrospective surgical cohort study.” Rhinology (2026). PMID: 41486815 ↗
L2COHORTCited in: Audiologic, Vestibular and Endoscopic Assessment, Severity, Staging and Risk Stratification - [189]
Jian F, Lao J, Ge R et al.. “A prospective cohort study comparing the effects of different middle turbinate treatments on olfactory function recovery in CRSwNP patients after FESS.” Rhinology (2025). PMID: 40587156 ↗
L2COHORTCited in: Audiologic, Vestibular and Endoscopic Assessment - [190]
Demir E, Uğurlu BN, Uğurlu GA et al.. “Artificial intelligence in otorhinolaryngology: current trends and application areas.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 40019544 ↗
L5REVIEW_NARRATIVECited in: Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup - [191]
Chang F, Hong J, Yuan F et al.. “Association between cognition and olfaction-specific parameters in patients with chronic rhinosinusitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2023). PMID: 36689021 ↗
L4OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment, Diagnostic Imaging, Tissue Sampling and Workup - [192]
Cantone E, Pezzella P, Manganello G et al.. “Short-term effectiveness of tezepelumab on ENT manifestations in patients undergoing treatment for severe asthma: A pilot real-life study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026). PMID: 41566024 ↗
L4OTHERCited in: Audiologic, Vestibular and Endoscopic Assessment - [193]
Chen T, Chidarala S, Young G et al.. “Association of Sinonasal Computed Tomography Scores to Patient-Reported Outcome Measures: A Systematic Review and Meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 35917187 ↗
L2SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification - [194]
Liang J, Higgins T, Ishman SL et al.. “Medical management of chronic rhinosinusitis in cystic fibrosis: a systematic review.” The Laryngoscope (2013). PMID: 24338982 ↗
L2SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification - [195]
Safi C, Li C, Tabaee A et al.. “Outcomes and imaging findings of respiratory epithelial adenomatoid hamartoma: a systematic review.” International forum of allergy & rhinology (2019). PMID: 30657648 ↗
L2SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup - [196]
Kyriakopoulos C, Ntritsos G, Gogali A et al.. “Efficacy of biologic agents in patients with comorbid asthma and chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis of randomised controlled trials.” European respiratory review : an official journal of the European Respiratory Society (2026). PMID: 41534885 ↗
L1SR_MA_RCTCited in: Diagnostic Imaging, Tissue Sampling and Workup - [197]
Tyler MA, Padro Dietz CJ, Russell CB et al.. “Distinguishing Molecular Features of Allergic Fungal Rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2018). PMID: 29584543 ↗
L3OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [198]
Chong LY, Piromchai P, Sharp S et al.. “Biologics for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2021). PMID: 33710614 ↗
L1SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Complications, Prognosis and Natural History, Special Populations and Pregnancy - [199]
Chong LY, Head K, Hopkins C et al.. “Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2016). PMID: 27115217 ↗
L1SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification, Acute and Emergency Management, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [200]
Chong LY, Piromchai P, Sharp S et al.. “Biologics for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2020). PMID: 32102112 ↗
L1SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Complications, Prognosis and Natural History, Special Populations and Pregnancy - [201]
Chong LY, Head K, Hopkins C et al.. “Saline irrigation for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2016). PMID: 27115216 ↗
L1SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Acute and Emergency Management, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Complications, Special Populations and Pregnancy - [202]
Head K, Sharp S, Chong LY et al.. “Topical and systemic antifungal therapy for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2018). PMID: 30199594 ↗
L1SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Acute and Emergency Management, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Complications, Special Populations and Pregnancy - [203]
Head K, Chong LY, Piromchai P et al.. “Systemic and topical antibiotics for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2016). PMID: 27113482 ↗
L1SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Complications, Special Populations and Pregnancy - [204]
Head K, Chong LY, Hopkins C et al.. “Short-course oral steroids alone for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2016). PMID: 27113367 ↗
L1SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification, Complications - [205]
Head K, Chong LY, Hopkins C et al.. “Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2016). PMID: 27115214 ↗
L1SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive) - [206]
Messineo D, Frisina P, Begvarfaj E et al.. “Endotype-Guided Imaging in Chronic Rhinosinusitis: HRCT/CBCT and MRI Metrics, Structured Reporting, and Radiomics-A Systematic Review.” Medical sciences (Basel, Switzerland) (2026). PMID: 42346813 ↗
L2SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [207]
Lee JY, Al Ali M, Kim SW et al.. “Fractional Exhaled Nitric Oxide for Diagnosing Eosinophilic Chronic Rhinosinusitis: A Systematic Review and Meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2026). PMID: 41521835 ↗
L3SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup - [208]
Jafari A, de Lima Xavier L, Bernstein JD et al.. “Association of Sinonasal Inflammation With Functional Brain Connectivity.” JAMA otolaryngology-- head & neck surgery (2021). PMID: 33830194 ↗
L3OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup, History and Evolution of Treatment - [209]
Bourdillon AT, Yao A, Bur AM. “Radiomics in Otolaryngology-Head and Neck Surgery: A Review.” JAMA otolaryngology-- head & neck surgery (2026). PMID: 41678150 ↗
L5REVIEW_NARRATIVECited in: Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Prognosis and Natural History, Special Populations and Pregnancy - [210]
Sheikh S, Ho ML, Eisner M et al.. “Elexacaftor-Tezacaftor-Ivacaftor Therapy for Chronic Sinus Disease in Cystic Fibrosis.” JAMA otolaryngology-- head & neck surgery (2023). PMID: 37676668 ↗
L2OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup, Special Populations and Pregnancy - [211]
Zhang SK, Gilani S, Stanlie A et al.. “Validation of an Adaptive Sinonasal Outcome Test.” JAMA otolaryngology-- head & neck surgery (2026). PMID: 42133337 ↗
L2OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [212]
Li W, Ho J, Grayson JW et al.. “Evaluation of Diffuse Type 2 Dominant or Eosinophilic Chronic Rhinosinusitis With Corticosteroid Irrigation After Surgical Neosinus Cavity Formation.” JAMA otolaryngology-- head & neck surgery (2021). PMID: 33538760 ↗
L2OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup, Complications - [213]
Conger BT, Zhang S, Skinner D et al.. “Comparison of cystic fibrosis transmembrane conductance regulator (CFTR) and ciliary beat frequency activation by the CFTR Modulators Genistein, VRT-532, and UCCF-152 in primary sinonasal epithelial cultures.” JAMA otolaryngology-- head & neck surgery (2013). PMID: 23949358 ↗
L5OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [214]
Dietz de Loos DA, Hopkins C, Fokkens WJ. “Symptoms in chronic rhinosinusitis with and without nasal polyps.” The Laryngoscope (2013). PMID: 23280941 ↗
L3OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [215]
Badash I, Serafino M, Correa A et al.. “Diagnosing Eosinophilic Chronic Rhinosinusitis in Excised Tissue Using Optical Coherence Tomography.” The Laryngoscope (2025). PMID: 41311123 ↗
L4OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [216]
Kazi A, West E, Rahman S et al.. “Pain Catastrophizing and Quality of Life in Adults With Chronic Rhinosinusitis.” The Laryngoscope (2021). PMID: 33513282 ↗
L4OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [217]
Loftus C, Schlosser RJ, Smith TL et al.. “Olfactory cleft and sinus opacification differentially impact olfaction in chronic rhinosinusitis.” The Laryngoscope (2019). PMID: 31603563 ↗
L2OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [218]
Workman AD, Kuppusamy K, Lerner DK et al.. “Assessing adequacy of surgical extent in CRSwNP: The Completion of Surgery Index.” International forum of allergy & rhinology (2024). PMID: 39264325 ↗
L3OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Special Populations and Pregnancy - [219]
Nakayama T, Inoue N, Akutsu M et al.. “Allergic Fungal Rhinosinusitis and Eosinophilic Chronic Rhinosinusitis Have Different Phenotypes in Japan.” International forum of allergy & rhinology (2025). PMID: 40299896 ↗
L3OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [220]
Ahn SH, Shin KH, Oh JT et al.. “Calprotectin in chronic rhinosinusitis eosinophil extracellular traps.” International forum of allergy & rhinology (2023). PMID: 36932634 ↗
L4OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [221]
Lee JY, Kim DH, Kim SW et al.. “Diagnostic criteria for eosinophilic chronic rhinosinusitis: Comparative analysis and novel scoring system.” International forum of allergy & rhinology (2024). PMID: 39039646 ↗
L3OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [222]
Li J, Mao N, Aodeng S et al.. “Development and Validation an Integrated Deep Learning Model to Assist Eosinophilic Chronic Rhinosinusitis Diagnosis: A Multicenter Study.” International forum of allergy & rhinology (2025). PMID: 40387008 ↗
L3OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [223]
Lin YT, Lin CF, Liao CK et al.. “Clinical characteristics and cytokine profiles of central-compartment-type chronic rhinosinusitis.” International forum of allergy & rhinology (2021). PMID: 33529479 ↗
L2OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [224]
Chitsuthipakorn W, Pooldum V, Hoang MP et al.. “Effect of Preoperative Systemic Steroids on Tissue Eosinophils in CRSwNP: Meta-Analysis.” The Laryngoscope (2026). PMID: 42062802 ↗
L2SR_OBSCited in: Diagnostic Imaging, Tissue Sampling and Workup - [225]
Elwany S, Shewel Y, Bazak R et al.. “Quitting smoking reverses nasal mucosal changes.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2020). PMID: 32166416 ↗
L4OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup, History and Evolution of Treatment - [226]
Karakahya RH, Korkmaz M, Korkmaz H. “Decreased retinal nerve fiber and choroidal thickness in chronic rhinosinusitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2021). PMID: 33704528 ↗
L4OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [227]
Sethi N. “The significance of osteitis in rhinosinusitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2014). PMID: 24771214 ↗
L5OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [228]
Zhou F, Cao C, Fan W et al.. “The imaging anatomy of ethmomaxillary sinus and its impact on chronic rhinosinusitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2020). PMID: 32879988 ↗
L4OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [229]
Wang J, Jiang Y, Chen X et al.. “Serum 25-hydroxyvitamin D levels and peripheral blood eosinophil percentages as predictive indicators for eosinophilic chronic sinusitis with nasal polyps.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 40025185 ↗
L3OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup - [230]
Zuo K, Guo J, Chen F et al.. “Clinical characteristics and surrogate markers of eosinophilic chronic rhinosinusitis in Southern China.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2014). PMID: 24493563 ↗
L4OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup, Severity, Staging and Risk Stratification - [231]
Chang KP, Chang YT, Wu CC et al.. “Multiplexed immunobead-based profiling of cytokine markers for detection of nasopharyngeal carcinoma and prognosis of patient survival.” Head & neck (2010). PMID: 21560180 ↗
L3OTHERCited in: Diagnostic Imaging, Tissue Sampling and Workup, Prognosis and Natural History - [232]
Tait S, Kallogjeri D, Suko J et al.. “Effect of Budesonide Added to Large-Volume, Low-pressure Saline Sinus Irrigation for Chronic Rhinosinusitis: A Randomized Clinical Trial.” JAMA otolaryngology-- head & neck surgery (2018). PMID: 29879268 ↗
L2RCTCited in: Severity, Staging and Risk Stratification, History and Evolution of Treatment, Prognosis and Natural History - [233]
Fujieda S, Matsune S, Takeno S et al.. “The Effect of Dupilumab on Intractable Chronic Rhinosinusitis with Nasal Polyps in Japan.” The Laryngoscope (2020). PMID: 33226139 ↗
L1RCTCited in: Severity, Staging and Risk Stratification, History and Evolution of Treatment - [234]
Alt JA, Sautter NB, Mace JC et al.. “Antisomnogenic cytokines, quality of life, and chronic rhinosinusitis: a pilot study.” The Laryngoscope (2013). PMID: 24115141 ↗
L4TRIAL_NONRANDOMCited in: Severity, Staging and Risk Stratification - [235]
Bachert C, Han JK, Desrosiers M et al.. “Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials.” Lancet (London, England) (2019). PMID: 31543428 ↗
L1RCTCited in: Severity, Staging and Risk Stratification, Acute and Emergency Management, Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Prognosis and Natural History, Special Populations and Pregnancy - [236]
DeConde AS, Thompson CF, Wu EC et al.. “Systematic review and meta-analysis of total intravenous anesthesia and endoscopic sinus surgery.” International forum of allergy & rhinology (2013). PMID: 23843351 ↗
L1SR_OBSCited in: Severity, Staging and Risk Stratification - [237]
Quintanilla-Dieck L, Litvack JR, Mace JC et al.. “Comparison of disease-specific quality-of-life instruments in the assessment of chronic rhinosinusitis.” International forum of allergy & rhinology (2012). PMID: 22696495 ↗
L5SR_OBSCited in: Severity, Staging and Risk Stratification - [238]
Garvey E, Duffy A, Tekumalla S et al.. “Obstructive Sleep Apnea and Chronic Rhinosinusitis: Understanding the Impact of OSA on CRS Disease Burden.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2024). PMID: 39575579 ↗
L3OTHERCited in: Severity, Staging and Risk Stratification, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Special Populations and Pregnancy - [239]
Ghannam JY, Zhou AS, Stanlie A et al.. “Effect of Body Mass Index on Sinonasal Symptoms and Imaging Results.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2026). PMID: 41815096 ↗
L4OTHERCited in: Severity, Staging and Risk Stratification - [240]
Phillips KM, Hoehle L, Bergmark RW et al.. “Reversal of Smoking Effects on Chronic Rhinosinusitis after Smoking Cessation.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2017). PMID: 28699423 ↗
L4OTHERCited in: Severity, Staging and Risk Stratification - [241]
Luong A, Ow RA, Singh A et al.. “Safety and Effectiveness of a Bioabsorbable Steroid-Releasing Implant for the Paranasal Sinus Ostia: A Randomized Clinical Trial.” JAMA otolaryngology-- head & neck surgery (2017). PMID: 29098299 ↗
L1OTHERCited in: Severity, Staging and Risk Stratification - [242]
Liu Y, Zeng X, Nie Z et al.. “Comparison the Impacts of Asthma and Allergic Rhinitis on Chronic Rhinosinusitis With Nasal Polyps.” The Laryngoscope (2025). PMID: 40586428 ↗
L3OTHERCited in: Severity, Staging and Risk Stratification, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [243]
Paramasivan S, Psaltis AJ, Wormald PJ et al.. “Tertiary Lymphoid Organs: A Primer for Otolaryngologists.” The Laryngoscope (2020). PMID: 33179781 ↗
L5REVIEW_NARRATIVECited in: Severity, Staging and Risk Stratification, Prognosis and Natural History - [244]
Miyake MM, Bleier BS. “Future topical medications in chronic rhinosinusitis.” International forum of allergy & rhinology (2019). PMID: 31087632 ↗
L5REVIEW_NARRATIVECited in: Severity, Staging and Risk Stratification, Acute and Emergency Management, Medical versus Surgical Management (Definitive) - [245]
Lou H, Zhang N, Bachert C et al.. “Highlights of eosinophilic chronic rhinosinusitis with nasal polyps in definition, prognosis, and advancement.” International forum of allergy & rhinology (2018). PMID: 30296011 ↗
L5REVIEW_NARRATIVECited in: Severity, Staging and Risk Stratification - [246]
Rubel KE, Lubner RJ, Lopez AA et al.. “Inflammatory characteristics of central compartment atopic disease.” International forum of allergy & rhinology (2023). PMID: 37302116 ↗
L4OTHERCited in: Severity, Staging and Risk Stratification - [247]
Pereira NM, Wie SJ, Zhao K et al.. “The Role of Artificial Intelligence in Chronic Rhinosinusitis: A Scoping Review.” International forum of allergy & rhinology (2025). PMID: 41376460 ↗
L5REVIEW_NARRATIVECited in: Severity, Staging and Risk Stratification - [248]
Lim S, Ramirez MV, Garneau JC et al.. “Three-dimensional image analysis for staging chronic rhinosinusitis.” International forum of allergy & rhinology (2017). PMID: 28941169 ↗
L4OTHERCited in: Severity, Staging and Risk Stratification - [249]
Lee AJ, Liu MW, Chaaban MR. “Obesity and New-Onset Asthma Risk in Chronic Rhinosinusitis: A Population-Based Cohort Study.” Laryngoscope investigative otolaryngology (2026). PMID: 42146118 ↗
L3COHORTCited in: Severity, Staging and Risk Stratification, Surgical Technique, Approaches and Perioperative Care - [250]
Miller AC, Boonstra DE, Cavanaugh JE et al.. “Age-Specific Risk and Severity of CRS among Cystic Fibrosis Carriers: A Population-Based Cohort Study.” The Annals of otology, rhinology, and laryngology (2025). PMID: 41461387 ↗
L3COHORTCited in: Severity, Staging and Risk Stratification - [251]
Ciofalo A, Cavaliere C, Incorvaia C et al.. “Diagnostic performance of nasal cytology.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2021). PMID: 34414469 ↗
L4OTHERCited in: Severity, Staging and Risk Stratification, Acute and Emergency Management, History and Evolution of Treatment - [252]
Asoegwu CN, Nwawolo CC, Okubadejo NU. “Translation and validation of the Rhinosinusitis Disability Index for use in Nigeria.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2017). PMID: 28293783 ↗
L4OTHERCited in: Severity, Staging and Risk Stratification - [253]
Schalek P, Hart L, Fuksa J et al.. “Quality of life in CRSwNP: evaluation of ACCESS and Lund-Mackay computed tomography scores versus the QoL questionnaire.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 35717639 ↗
L4OTHERCited in: Severity, Staging and Risk Stratification - [254]
Huang X, Liu Z, Bleier BS et al.. “Association of mucus eosinophil-derived neurotoxin levels with disease control status in patients with chronic rhinosinusitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 38700538 ↗
L3OTHERCited in: Severity, Staging and Risk Stratification - [255]
Iro H, Mayr S, Schick B et al.. “Clinical outcome of partial ethmoidectomy for chronic rhinosinusitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2006). PMID: 16496109 ↗
L4OTHERCited in: Severity, Staging and Risk Stratification - [256]
Rosenfeld RM. “Clinical practice guideline on adult sinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2007). PMID: 17765760 ↗
L1GUIDELINECited in: Acute and Emergency Management - [257]
Guo R, Canter PH, Ernst E. “Herbal medicines for the treatment of rhinosinusitis: a systematic review.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2006). PMID: 17011407 ↗
L1SR_OBSCited in: Acute and Emergency Management, Special Populations and Pregnancy - [258]
Kim JS, Stybayeva G, Hwang SH. “Effectiveness of Vidian Neurectomy in Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review and Meta-Analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2024). PMID: 39467055 ↗
L1SR_OBSCited in: Acute and Emergency Management, Complications, Prognosis and Natural History - [259]
Sethi R, Oral K, Guda R et al.. “The Statistical Fragility of Saline Nasal Irrigation for Rhinosinusitis: A Systematic Review.” The Laryngoscope (2026). PMID: 42053165 ↗
L1SR_OBSCited in: Acute and Emergency Management - [260]
Soler ZM, Oyer SL, Kern RC et al.. “Antimicrobials and chronic rhinosinusitis with or without polyposis in adults: an evidenced-based review with recommendations.” International forum of allergy & rhinology (2012). PMID: 22736403 ↗
L2SR_OBSCited in: Acute and Emergency Management, Prognosis and Natural History - [261]
Larivée N, Chin CJ. “Aspirin desensitization therapy in aspirin-exacerbated respiratory disease: a systematic review.” International forum of allergy & rhinology (2020). PMID: 31951112 ↗
L2SR_OBSCited in: Acute and Emergency Management - [262]
Makary CA, Azar A, Gudis D et al.. “Evaluation and treatment of rhinosinusitis with primary antibody deficiency in children: Evidence-based review with recommendations.” International forum of allergy & rhinology (2024). PMID: 39404739 ↗
L2SR_OBSCited in: Acute and Emergency Management - [263]
Dinaki K, Grigoriadis N, Vizirianakis IS et al.. “The impact of submucosal PRP injection on wound healing after endoscopic sinus surgery: a randomized clinical trial.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 38334783 ↗
L1RCTCited in: Acute and Emergency Management - [264]
Eisenhut M. “Rhinorrhea and increased chloride secretion through the CFTR chloride channel-a systematic review.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2023). PMID: 37338585 ↗
L2SR_OBSCited in: Acute and Emergency Management - [265]
Kang YJ, Stybayeva G, Hwang SH. “Effectiveness of the exhalation delivery system with fluticasone for treating chronic rhinosinusitis with nasal polyposis: a systematic review and meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 39572411 ↗
L1SR_OBSCited in: Acute and Emergency Management, Complications - [266]
Krouse JH, Brown RW, Fineman SM et al.. “Asthma and the unified airway.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2007). PMID: 17462497 ↗
L5REVIEW_NARRATIVECited in: Acute and Emergency Management - [267]
Bentan MA, Pingree G, Lee L et al.. “Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis.” The Laryngoscope (2024). PMID: 39290040 ↗
L2OTHERCited in: Acute and Emergency Management - [268]
Banoub RG, Phillips KM, Hoehle LP et al.. “Relationship between chronic rhinosinusitis exacerbation frequency and asthma control.” The Laryngoscope (2017). PMID: 28963721 ↗
L4OTHERCited in: Acute and Emergency Management - [269]
Speth MM, Phillips KM, Hoehle LP et al.. “Appropriate medical management of chronic rhinosinusitis reduces use of antibiotics and oral corticosteroids.” The Laryngoscope (2019). PMID: 31846092 ↗
L2OTHERCited in: Acute and Emergency Management - [270]
Makary CA, Behnke J, Peppers B et al.. “Outcome of Immunoglobulin Replacement Therapy in Adults With Rhinosinusitis.” The Laryngoscope (2021). PMID: 34146351 ↗
L2OTHERCited in: Acute and Emergency Management, Medical versus Surgical Management (Definitive) - [271]
Liao B, Hu CY, Liu T et al.. “Respiratory viral infection in the chronic persistent phase of chronic rhinosinusitis.” The Laryngoscope (2013). PMID: 23929535 ↗
L3OTHERCited in: Acute and Emergency Management - [272]
Dao AM, Rereddy SK, Wise SK et al.. “Management of non-invasive rhinosinusitis in the immunosuppressed patient population.” The Laryngoscope (2015). PMID: 25946593 ↗
L2OTHERCited in: Acute and Emergency Management - [273]
Mundy DC, Yan CH, Tyler MA et al.. “A Consistent Endoscopic Landmark to Identify the Anterior Ethmoidal Artery.” The Laryngoscope (2023). PMID: 37578267 ↗
L4OTHERCited in: Acute and Emergency Management - [274]
Bhattacharyya N. “Contemporary Incremental Healthcare Costs for Chronic Rhinosinusitis in the United States.” The Laryngoscope (2021). PMID: 33606274 ↗
L2OTHERCited in: Acute and Emergency Management - [275]
BuSaba NY, Cunningham MJ. “Connexin 26 and 30 genes mutations in patients with chronic rhinosinusitis.” The Laryngoscope (2008). PMID: 17989577 ↗
L4OTHERCited in: Acute and Emergency Management - [276]
Kim R, Chang G, Hu R et al.. “Connexin gap junction channels and chronic rhinosinusitis.” International forum of allergy & rhinology (2016). PMID: 26919292 ↗
L3OTHERCited in: Acute and Emergency Management - [277]
Antkowiak M, Domka J, Kasza R et al.. “Complications of controlled hypotension during functional endoscopic sinus surgery - a systematic review.” BMC anesthesiology (2026). PMID: 42286476 ↗
L5SR_OBSCited in: Acute and Emergency Management, Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prevention, Screening and Surveillance - [278]
Quiñones Cabrera P, Ordóñez Suquilanda MG, Castro-Rodriguez JA. “Changing the Underlying Causes of Recurrent Pneumonia In Children: A Systematic Review.” Pediatric pulmonology (2025). PMID: 41293969 ↗
L4SR_OBSCited in: Acute and Emergency Management, Complications - [279]
Kokot K, Fercho JM, Duszyński K et al.. “Pott's Puffy Tumor in the Adult Population: Systematic Review and Meta-Analysis of Case Reports.” Journal of clinical medicine (2025). PMID: 40565808 ↗
L4SR_OBSCited in: Acute and Emergency Management - [280]
Gleadhill C, Speth MM, Gengler I et al.. “Chronic rhinosinusitis disease burden is associated with asthma-related emergency department usage.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2020). PMID: 32749608 ↗
L2OTHERCited in: Acute and Emergency Management - [281]
Su YW, Huang WH, Yeh CF. “Pantoea dispersa rhinosinusitis: clinical aspects of a rare sinonasal pathogen.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 35076743 ↗
L4OTHERCited in: Acute and Emergency Management - [282]
Yaniv D, Stern D, Vainer I et al.. “The bacteriology of recurrent acute exacerbations of chronic rhinosinusitis: a longitudinal analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2020). PMID: 32623506 ↗
L4OTHERCited in: Acute and Emergency Management - [283]
Liu DT, Schally M, Schneider S et al.. “Annual trends in Google searches provides insights related to rhinosinusitis exacerbations.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2021). PMID: 33877434 ↗
L2OTHERCited in: Acute and Emergency Management - [284]
Azzi A, Alotaibi AS, Alamri MS et al.. “The Efficacy of Probiotics in Treating Upper Respiratory Tract Infections, Allergic Rhinitis, and Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.” Microorganisms (2026). PMID: 42197372 ↗
L1SR_OBSCited in: Acute and Emergency Management - [285]
Kohli P, Naik AN, Farhood Z et al.. “Olfactory Outcomes after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2016). PMID: 27576679 ↗
L4SR_OBSCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [286]
Sukato DC, Abramowitz JM, Boruk M et al.. “Endoscopic Sinus Surgery Improves Sleep Quality in Chronic Rhinosinusitis: A Systematic Review and Meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2017). PMID: 29065273 ↗
L4SR_OBSCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [287]
Caulley L, James J, Hopkins C. “Use of Nonmedicated Control Substances in Randomized Clinical Trials of Patients With Chronic Rhinosinusitis: A Systematic Review and Single-Arm Meta-analysis.” JAMA otolaryngology-- head & neck surgery (2021). PMID: 33180113 ↗
L4SR_OBSCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [288]
Carlton DA, Beahm DD, Chiu AG. “Topical antibiotic therapy in chronic rhinosinusitis: an update.” International forum of allergy & rhinology (2019). PMID: 31087634 ↗
L5SR_OBSCited in: Medical versus Surgical Management (Definitive), Special Populations and Pregnancy - [289]
Smith KA, Kingdom TT, Gray ST et al.. “Drug-eluting implants in chronic rhinosinusitis: an evidence-based review with recommendations.” International forum of allergy & rhinology (2020). PMID: 32479698 ↗
L5SR_OBSCited in: Medical versus Surgical Management (Definitive) - [290]
Homøe AS, Aanæs K, Tidemandsen JE et al.. “Superior Benefits of Combining Mepolizumab With Sinus Surgery Compared to Mepolizumab Alone: Results From a Randomised 6-Month Trial.” International forum of allergy & rhinology (2025). PMID: 40065601 ↗
L1RCTCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History, Special Populations and Pregnancy - [291]
Wang H, Xu X, Lu Z et al.. “Efficacy of different biologics for treating chronic rhinosinusitis with nasal polyps: a network meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 39187717 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive), Prognosis and Natural History, Special Populations and Pregnancy - [292]
Bertazzoni G, Conti C, Testa G et al.. “High volume nasal irrigations with steroids for chronic rhinosinusitis and allergic rhinitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 39327287 ↗
L5SR_OBSCited in: Medical versus Surgical Management (Definitive), Special Populations and Pregnancy - [293]
Wang TC, Tai CJ, Tsou YA et al.. “Absorbable and nonabsorbable packing after functional endoscopic sinus surgery: systematic review and meta-analysis of outcomes.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2014). PMID: 24927828 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Complications - [294]
Gevaert P, Desrosiers M, Cornet M et al.. “Efficacy and safety of twice per year depemokimab in chronic rhinosinusitis with nasal polyps (ANCHOR-1 and ANCHOR-2): phase 3, randomised, double-blind, parallel trials.” Lancet (London, England) (2025). PMID: 40037388 ↗
L1RCTCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History, Special Populations and Pregnancy - [295]
Philpott C, Beard DJ, Saeedi E et al.. “The clinical effectiveness of clarithromycin versus endoscopic sinus surgery for adults with chronic rhinosinusitis with and without nasal polyps (MACRO): a pragmatic, multicentre, three-arm, randomised, placebo-controlled phase 4 trial.” Lancet (London, England) (2025). PMID: 40885584 ↗
L1RCTCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History, Special Populations and Pregnancy - [296]
El Malt HH, Elaissaoui S, De Cesaro Schpchacki N et al.. “Clinical Efficacy of Tezepelumab in Moderate-to-Severe Uncontrolled Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review of Randomized Controlled Trials.” American journal of rhinology & allergy (2026). PMID: 42377059 ↗
L1SR_MA_RCTCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [297]
Massey CJ, Suh JD, Tessema B et al.. “Biomaterials in Rhinology.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2016). PMID: 26908551 ↗
L5REVIEW_NARRATIVECited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Complications, Prognosis and Natural History - [298]
Damask CC, Ryan MW, Casale TB et al.. “Targeted Molecular Therapies in Allergy and Rhinology.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2020). PMID: 33138725 ↗
L5REVIEW_NARRATIVECited in: Medical versus Surgical Management (Definitive) - [299]
. “Erratum.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2014). PMID: 29135388 ↗
L5OTHERCited in: Medical versus Surgical Management (Definitive) - [300]
Talati VM, Brown HJ, Kim YJ et al.. “Histopathologic Features of Chronic Rhinosinusitis in Diabetic Patients.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 36939423 ↗
L2OTHERCited in: Medical versus Surgical Management (Definitive) - [301]
Khalil HS, Nunez DA. “Functional endoscopic sinus surgery for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2006). PMID: 16856048 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [302]
Kalish L, Snidvongs K, Sivasubramaniam R et al.. “Topical steroids for nasal polyps.” The Cochrane database of systematic reviews (2012). PMID: 23235631 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive), Complications, Prognosis and Natural History, Special Populations and Pregnancy - [303]
Almeida PRL, Person OC, Puga ME et al.. “Surgery for nasal polyposis in cystic fibrosis.” The Cochrane database of systematic reviews (2023). PMID: 38063253 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History, Special Populations and Pregnancy - [304]
Ahmed J, Pal S, Hopkins C et al.. “Functional endoscopic balloon dilation of sinus ostia for chronic rhinosinusitis.” The Cochrane database of systematic reviews (2011). PMID: 21735433 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [305]
Sharma R, Lakhani R, Rimmer J et al.. “Surgical interventions for chronic rhinosinusitis with nasal polyps.” The Cochrane database of systematic reviews (2014). PMID: 25410644 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive) - [306]
Sacks PL, Harvey RJ, Rimmer J et al.. “Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis.” The Cochrane database of systematic reviews (2011). PMID: 21833965 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive) - [307]
Sacks PL, Harvey RJ, Rimmer J et al.. “WITHDRAWN: Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis.” The Cochrane database of systematic reviews (2018). PMID: 30184244 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment - [308]
Han JK, Mullol J, Hopkins C et al.. “Indirect Treatment Comparison of Tezepelumab Versus Other Biologics in Severe Chronic Rhinosinusitis with Nasal Polyps: A Systematic Literature Review and Network Meta-analysis.” Advances in therapy (2026). PMID: 42283959 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [309]
Gill AS, Beswick DM, Mace JC et al.. “Evaluating Distance Bias in Chronic Rhinosinusitis Outcomes.” JAMA otolaryngology-- head & neck surgery (2022). PMID: 35511170 ↗
L4OTHERCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care - [310]
Beswick DM, Ramakrishnan VR. “The Utility of Image Guidance in Endoscopic Sinus Surgery: A Narrative Review.” JAMA otolaryngology-- head & neck surgery (2020). PMID: 31917412 ↗
L5REVIEW_NARRATIVECited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [311]
Ooi ML, Drilling AJ, Morales S et al.. “Safety and Tolerability of Bacteriophage Therapy for Chronic Rhinosinusitis Due to Staphylococcus aureus.” JAMA otolaryngology-- head & neck surgery (2019). PMID: 31219531 ↗
L4OTHERCited in: Medical versus Surgical Management (Definitive), Complications - [312]
Hutson K, Clark A, Hopkins C et al.. “Evaluation of Smoking as a Modifying Factor in Chronic Rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2021). PMID: 33300989 ↗
L3OTHERCited in: Medical versus Surgical Management (Definitive) - [313]
Rudmik L, Xu Y, Alt JA et al.. “Evaluating Surgeon-Specific Performance for Endoscopic Sinus Surgery.” JAMA otolaryngology-- head & neck surgery (2017). PMID: 28655057 ↗
L2OTHERCited in: Medical versus Surgical Management (Definitive) - [314]
DeConde AS, Bodner TE, Mace JC et al.. “Response shift in quality of life after endoscopic sinus surgery for chronic rhinosinusitis.” JAMA otolaryngology-- head & neck surgery (2014). PMID: 25074504 ↗
L2OTHERCited in: Medical versus Surgical Management (Definitive) - [315]
Wang F, Song Y, Zhang X et al.. “Sinus balloon catheter dilation in pediatric chronic rhinosinusitis resistant to medical therapy.” JAMA otolaryngology-- head & neck surgery (2015). PMID: 25835158 ↗
L3OTHERCited in: Medical versus Surgical Management (Definitive), Special Populations and Pregnancy - [316]
Yoshikawa M, Okano M, Takeuchi M et al.. “Reduction of Rescue Treatment With Dupilumab for Chronic Rhinosinusitis With Nasal Polyps in Japan.” The Laryngoscope (2025). PMID: 40257287 ↗
L2OTHERCited in: Medical versus Surgical Management (Definitive), Prognosis and Natural History - [317]
Patel PA, Kallenberger EM, Nguyen SA et al.. “Factors Affecting Nasal Discharge in Chronic Rhinosinusitis Patients.” The Laryngoscope (2025). PMID: 40417805 ↗
L4OTHERCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Special Populations and Pregnancy - [318]
Haxel BR. “Recovery of olfaction after sinus surgery for chronic rhinosinusitis: A review.” The Laryngoscope (2019). PMID: 30623432 ↗
L5REVIEW_NARRATIVECited in: Medical versus Surgical Management (Definitive) - [319]
Li YT, Huang SS, Ma JH et al.. “Bacteriology of Different Phenotypes of Chronic Rhinosinusitis.” The Laryngoscope (2023). PMID: 37477266 ↗
L3OTHERCited in: Medical versus Surgical Management (Definitive) - [320]
Hur K, Gao J, Adili A et al.. “Treatment Decision-Making Among Chinese Americans With Chronic Rhinosinusitis.” The Laryngoscope (2025). PMID: 39744809 ↗
L2OTHERCited in: Medical versus Surgical Management (Definitive) - [321]
Herrera K, Parikh M, Vemula S et al.. “Effect of Hormone Replacement Therapy on Chronic Rhinosinusitis Management.” The Laryngoscope (2024). PMID: 38554029 ↗
L2OTHERCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Special Populations and Pregnancy - [322]
Lee SE, Ritter E, Nguyen TT et al.. “In Vivo Fluticasone Absorption in Surgical Patients.” The Laryngoscope (2023). PMID: 37694807 ↗
L4OTHERCited in: Medical versus Surgical Management (Definitive), Special Populations and Pregnancy - [323]
Dorling M, Sarafan M, Voizard B et al.. “Switching biologics in chronic rhinosinusitis with nasal polyps: A multicenter Canadian experience.” International forum of allergy & rhinology (2024). PMID: 39422074 ↗
L2OTHERCited in: Medical versus Surgical Management (Definitive), Special Populations and Pregnancy - [324]
Grayson JW, Harvey RJ. “Topical corticosteroid irrigations in chronic rhinosinusitis.” International forum of allergy & rhinology (2019). PMID: 31087637 ↗
L5REVIEW_NARRATIVECited in: Medical versus Surgical Management (Definitive) - [325]
Li F, Tian S, Wang K et al.. “Mid-term efficacy of endoscopic posterior nasal nerve neurectomy combined with functional endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps: a multicenter randomized controlled Trial.” Acta oto-laryngologica (2026). PMID: 42340871 ↗
L1RCTCited in: Medical versus Surgical Management (Definitive) - [326]
Ouranos K, Michael M, Mylona EK et al.. “Comparative Efficacy of Biologic Agents for Severe Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review and Network Meta-analysis.” The Journal of allergy and clinical immunology (2026). PMID: 42398863 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive) - [327]
Shahid MS, Naeem N, Lone MD et al.. “Comparative Restenosis and Revision Rates of Draf IIB Versus Draf III Frontal Sinusotomy in Chronic Rhinosinusitis: A Meta-Analysis Stratified by Endotype.” American journal of rhinology & allergy (2026). PMID: 42300720 ↗
L2SR_OBSCited in: Medical versus Surgical Management (Definitive) - [328]
Almukhlifi AK, Almutairi AO, Alansari LS et al.. “The Effect of Chitosan-Based Dressings on Postoperative Outcomes in Patients Undergoing Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis.” American journal of rhinology & allergy (2026). PMID: 42273764 ↗
L1SR_OBSCited in: Medical versus Surgical Management (Definitive) - [329]
Hoang MP, Doan HTT, Phan MHN et al.. “Vietnamese SNOT-22 Validation: Prospective Cohort Study on Sinonasal Symptoms And Health-Related Quality of Life.” OTO open (2026). PMID: 42256729 ↗
L2COHORTCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [330]
Corrales-Millán R, Maza-Solano J, Benito-Navarro JR et al.. “Real-world impact of mepolizumab on symptom control and health utility in severe chronic rhinosinusitis with nasal polyps: the RINOSUR 2.0 multicenter cohort study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026). PMID: 42228110 ↗
L2COHORTCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [331]
Krajewska J, Zub K, Słowikowski A et al.. “Chronic rhinosinusitis in cystic fibrosis: a review of therapeutic options.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2021). PMID: 34296343 ↗
L5REVIEW_NARRATIVECited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care, Special Populations and Pregnancy - [332]
Aguiar C, Valente P, Medeiros N et al.. “Predictive factors of revision endoscopic sinus surgery.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2023). PMID: 36763151 ↗
L3OTHERCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [333]
Joustra GE, den Heijer MC, Al Yousef RQH et al.. “Long-term clinical control in chronic rhinosinusitis: Outcomes more than five years after surgery.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 40782154 ↗
L3OTHERCited in: Medical versus Surgical Management (Definitive) - [334]
Orlando P, Vivarelli E, Minzoni A et al.. “Effects of Mepolizumab in the treatment of type 2 CRSwNP: a real-life clinical study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 39404884 ↗
L3OTHERCited in: Medical versus Surgical Management (Definitive), Surgical Technique, Approaches and Perioperative Care - [335]
Wei HZ, Li YC, Wang XD et al.. “The microbiology of chronic rhinosinusitis with and without nasal polyps.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2018). PMID: 29569134 ↗
L3OTHERCited in: Medical versus Surgical Management (Definitive), History and Evolution of Treatment, Surgical Technique, Approaches and Perioperative Care - [336]
Chen Y, Zhang X. “Endoscopic sinus surgery combined with nasal corticosteroids and surgery alone for chronic rhinosinusitis with nasal polyps: a meta-analysis.” BMC surgery (2026). PMID: 42337457 ↗
L2SR_OBSCited in: Medical versus Surgical Management (Definitive) - [337]
Yan B, Jin Z, Zhang L et al.. “[Quality of life improvement with stapokibart in chronic rhinosinusitis with nasal polyps: a post hoc analysis of phase 3 CROWNS-2 study].” Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery (2026). PMID: 42402685 ↗
L1RCTCited in: Medical versus Surgical Management (Definitive) - [338]
Hou S, Zheng Y, Wang L et al.. “[Efficacy assessment of stapokibart in chronic rhinosinusitis with nasal polyps stratified by Type 2 inflammation-related clinical characteristics].” Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery (2026). PMID: 42402683 ↗
L1RCTCited in: Medical versus Surgical Management (Definitive) - [339]
Deng Y, Shen S, Xian M et al.. “[Early response to stapokibart predicts long-term efficacy in patients with chronic rhinosinusitis with nasal polyps].” Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery (2026). PMID: 42402682 ↗
L1RCTCited in: Medical versus Surgical Management (Definitive) - [340]
van den Berg JW, de Nier LM, Kaper NM et al.. “Limited evidence: higher efficacy of nasal saline irrigation over nasal saline spray in chronic rhinosinusitis--an update and reanalysis of the evidence base.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2013). PMID: 24243927 ↗
L1RCTCited in: History and Evolution of Treatment - [341]
Candelo E, McCalla M, Valderrama OA et al.. “Relationship Between Alcohol Intolerance and Aspirin-Exacerbated Respiratory Disease (AERD): Systematic Review.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 36939486 ↗
L2SR_OBSCited in: History and Evolution of Treatment - [342]
Hopkins C, Mullol J, Khan AH et al.. “Impact of Dupilumab on Sinonasal Symptoms and Outcomes in Severe Chronic Rhinosinusitis With Nasal Polyps.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 38156522 ↗
L1RCTCited in: History and Evolution of Treatment - [343]
Hwang CS, Al Sharhan SS, Kim BR et al.. “Randomized controlled trial of steroid-soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery.” The Laryngoscope (2017). PMID: 28940582 ↗
L1RCTCited in: History and Evolution of Treatment - [344]
Desrosiers M, Diamant Z, Castelnuovo P et al.. “Sustained efficacy of mepolizumab in patients with severe chronic rhinosinusitis with nasal polyps: SYNAPSE 24-week treatment-free follow-up.” International forum of allergy & rhinology (2023). PMID: 37345861 ↗
L1RCTCited in: History and Evolution of Treatment, Prognosis and Natural History, Special Populations and Pregnancy - [345]
Tidemandsen J, Backer V, Homøe AS et al.. “The Global Airways in Practice: Long-term Effects of Mepolizumab With or Without FESS on Type 2 Inflammation in Patients With CRSwNP.” International forum of allergy & rhinology (2025). PMID: 41395863 ↗
L3RCTCited in: History and Evolution of Treatment - [346]
Antonio MA, Marson FAL, Toro MDC et al.. “Topical tretinoin in chronic rhinosinusitis with nasal polyps: a randomized clinical trial.” International forum of allergy & rhinology (2021). PMID: 33583149 ↗
L1RCTCited in: History and Evolution of Treatment - [347]
Mullol J, Han JK, Laidlaw TM et al.. “Early and Sustained Improvements in Sense of Smell With Tezepelumab Treatment in Patients With Chronic Rhinosinusitis With Nasal Polyps (WAYPOINT).” International forum of allergy & rhinology (2026). PMID: 41493192 ↗
L1RCTCited in: History and Evolution of Treatment - [348]
Benninger MS, Anon J, Mabry RL. “The medical management of rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (1997). PMID: 9334787 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [349]
Ward GW, Karlsson G, Rose G et al.. “Trichophyton asthma: sensitisation of bronchi and upper airways to dermatophyte antigen.” Lancet (London, England) (1989). PMID: 2564948 ↗
L1RCTCited in: History and Evolution of Treatment - [350]
Mittal Y, Pradhan P, Sarkar S et al.. “Posterior nasal nerve neurectomy for the treatment of chronic rhinosinusitis with nasal polyposis: a randomized controlled trial.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 36331590 ↗
L1RCTCited in: History and Evolution of Treatment - [351]
Samarei R, Rasouli J, Mehdikhani F. “Efficacy of triamcinolone acetonide-impregnated Gelfoam nasal pack in management of chronic sinusitis with nasal polyps following endoscopic sinus surgery: a perfectly matched, placebo-controlled trial study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2021). PMID: 34559269 ↗
L1RCTCited in: History and Evolution of Treatment - [352]
Abdelhamid HI, Awad AMM, Albadea AMA et al.. “A novel technique with butterfly splint for middle turbinate stabilization in sinus surgery.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2023). PMID: 37966539 ↗
L1RCTCited in: History and Evolution of Treatment - [353]
Wang L, Lv Y, Chang X et al.. “The effectiveness of evidence-based nursing intervention for nasal irrigation after endoscopic sinus surgery in patients with chronic rhinosinusitis: a randomized controlled trial.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 38189966 ↗
L1RCTCited in: History and Evolution of Treatment - [354]
Tomoum MO, ElSheikh MN, ElBasty H et al.. “Anterior part middle turbinoplasty in endoscopic sinus surgery: a randomized controlled study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2021). PMID: 34453573 ↗
L1RCTCited in: History and Evolution of Treatment - [355]
Novi SL, Navarathna N, D'Cruz M et al.. “Deep Learning in Otolaryngology: A Narrative Review.” JAMA otolaryngology-- head & neck surgery (2026). PMID: 41231484 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment, Prognosis and Natural History - [356]
Scangas GA, Gudis DA, Kennedy DW. “The natural history and clinical characteristics of paranasal sinus mucoceles: a clinical review.” International forum of allergy & rhinology (2013). PMID: 23696282 ↗
L4REVIEW_NARRATIVECited in: History and Evolution of Treatment - [357]
Barrow EM, Wise SK, Botros A et al.. “Central Compartment Atopic Disease: Analysis of Current Literature and Proposal of Diagnostic Criteria.” International forum of allergy & rhinology (2025). PMID: 40844498 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [358]
Snidvongs K, Kalish L, Sacks R et al.. “WITHDRAWN: Topical steroid for chronic rhinosinusitis without polyps.” The Cochrane database of systematic reviews (2016). PMID: 27111710 ↗
L1SR_OBSCited in: History and Evolution of Treatment - [359]
Kalish L, Snidvongs K, Sivasubramaniam R et al.. “WITHDRAWN: Topical steroids for nasal polyps.” The Cochrane database of systematic reviews (2016). PMID: 27111709 ↗
L1SR_OBSCited in: History and Evolution of Treatment - [360]
Harvey RJ, Hannan SA, Badia L et al.. “WITHDRAWN: Nasal saline irrigations for the symptoms of chronic rhinosinusitis.” The Cochrane database of systematic reviews (2016). PMID: 27110699 ↗
L1SR_OBSCited in: History and Evolution of Treatment - [361]
Piromchai P, Thanaviratananich S, Laopaiboon M. “WITHDRAWN: Systemic antibiotics for chronic rhinosinusitis without nasal polyps in adults.” The Cochrane database of systematic reviews (2016). PMID: 27111832 ↗
L1SR_OBSCited in: History and Evolution of Treatment - [362]
Wechsler ME, Pavord ID, Panettieri RA et al.. “Early and Sustained Efficacy of Depemokimab in Type 2 Asthma: A Pooled Analysis of the SWIFT-1/-2 Studies.” The journal of allergy and clinical immunology. In practice (2026). PMID: 41903881 ↗
L1RCTCited in: History and Evolution of Treatment, Prognosis and Natural History, Special Populations and Pregnancy - [363]
Vennik J, McDermott C, Williams SJ et al.. “Chronic rhinosinusitis: a qualitative study of patient and clinician experiences of the MACRO randomised controlled trial of surgical versus medical management.” BMJ open (2026). PMID: 41813048 ↗
L5RCTCited in: History and Evolution of Treatment, Special Populations and Pregnancy - [364]
Lugogo NL, Han JK, Peters AT et al.. “Tezepelumab's effects on patient-reported symptoms in severe asthma, overall and with history of comorbid chronic rhinosinusitis with nasal polyps (CRSwNP).” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2026). PMID: 41692339 ↗
L1RCTCited in: History and Evolution of Treatment - [365]
Sant'Ana J, Pontes I, Floriano C et al.. “Effect of Budesonide Nasal Irrigation in Patients With Chronic Rhinosinusitis With Nasal Polyps Without Prior Sinus Surgery: A Randomized, Double-Blind, Placebo-Controlled Study.” International forum of allergy & rhinology (2026). PMID: 41686524 ↗
L1RCTCited in: History and Evolution of Treatment - [366]
De Santis S, Galassi S, Cambi J. “Clinical Effects and Response Time of Biological Drugs in Chronic Rhinosinusitis with Nasal Polyps Patients: Real-life Experience.” The Laryngoscope (2024). PMID: 39651676 ↗
L2OTHERCited in: History and Evolution of Treatment - [367]
Wang AJ, Jiang R, Runyan T et al.. “Adverse Effects of Dupilumab for Chronic Rhinosinusitis With Nasal Polyposis: Real-World Single Institution Experience.” The Laryngoscope (2025). PMID: 40525458 ↗
L2OTHERCited in: History and Evolution of Treatment, Complications - [368]
Pirola F, Vezzoli E, Falqui A et al.. “Nasal Mucosa Regeneration After Reboot Surgery: Electron Microscopy and Histology Insights in CRSwNP.” The Laryngoscope (2025). PMID: 40237581 ↗
L4OTHERCited in: History and Evolution of Treatment - [369]
Dorling M, Hernaiz-Leonardo JC, Pascual A et al.. “Real-World Adverse Events After Type 2 Biologic use in Chronic Rhinosinusitis with Nasal Polyps.” The Laryngoscope (2024). PMID: 38314858 ↗
L2OTHERCited in: History and Evolution of Treatment - [370]
Lehmann AE, Scangas GA, Sethi RKV et al.. “Impact of Age on Sinus Surgery Outcomes.” The Laryngoscope (2018). PMID: 30284254 ↗
L2OTHERCited in: History and Evolution of Treatment - [371]
Chen Y, Dales R, Lin M. “The epidemiology of chronic rhinosinusitis in Canadians.” The Laryngoscope (2003). PMID: 12838019 ↗
L2OTHERCited in: History and Evolution of Treatment - [372]
Olcott CM, Han JK, Cunningham TD et al.. “Interleukin-9 and interleukin-17C in chronic rhinosinusitis.” International forum of allergy & rhinology (2016). PMID: 26989880 ↗
L3OTHERCited in: History and Evolution of Treatment - [373]
Gill AS, Tullis B, Mace JC et al.. “Health care disparities and chronic rhinosinusitis: Does neighborhood disadvantage impact outcomes in sinonasal disease?” International forum of allergy & rhinology (2024). PMID: 38367249 ↗
L2OTHERCited in: History and Evolution of Treatment - [374]
Alobid I, Del Cuvillo A, Mullol J et al.. “Advances in the management of chronic rhinosinusitis with nasal polyps. Review of multidisciplinary strategies and innovations in biological treatments.” Acta otorrinolaringologica espanola (2026). PMID: 41864502 ↗
L5GUIDELINECited in: History and Evolution of Treatment - [375]
Dobrakowski Ł, Kalisiak M, Majak J et al.. “Predicting the course of chronic rhinosinusitis in young children-5-year prospective study.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42418237 ↗
L2COHORTCited in: History and Evolution of Treatment, Prognosis and Natural History, Special Populations and Pregnancy - [376]
Montoro Ferrer A, Moro Moro MDM, Parra Borreguero FM et al.. “Real-World Response to Dupilumab as Add-on Therapy in Adults and Adolescents with Type 2 Severe Asthma: A Spanish Cohort Study.” Journal of asthma and allergy (2026). PMID: 41953432 ↗
L2COHORTCited in: History and Evolution of Treatment - [377]
Golet M, Cruz Toro P, Llansana Ríos A et al.. “High Response Rates and Predictors in Patients with CRSwNP Treated With Mepolizumab and Dupilumab: Results From a Prospective, Multicenter Cohort Study.” American journal of rhinology & allergy (2026). PMID: 41940839 ↗
L2COHORTCited in: History and Evolution of Treatment - [378]
Hildebrandt ME, Møller PR, Fjældstad AW et al.. “Postinfectious conditions challenge disease-specificity of SNOT-22.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 38177896 ↗
L3OTHERCited in: History and Evolution of Treatment - [379]
Lin H, Lin D, Xiong XS et al.. “Downregulation of caveolin-1 in chronic rhinosinusitis with and without nasal polyps.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2014). PMID: 24943192 ↗
L3OTHERCited in: History and Evolution of Treatment - [380]
Suikkila A, Lyly A, Savinko T et al.. “Inflammatory Cytokines in Middle Ear Effusion of Patients With Asthma, Chronic Rhinosinusitis With Nasal Polyps With or Without NSAID Intolerance.” Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2024). PMID: 38896805 ↗
L3OTHERCited in: History and Evolution of Treatment, Special Populations and Pregnancy - [381]
Wang Q, Shi R, Yan Y et al.. “Effectiveness of a cognitive behavioural therapy on patients with chronic rhinosinusitis with nasal polyps: a randomised controlled trial.” The Journal of laryngology and otology (2026). PMID: 41649002 ↗
L1RCTCited in: History and Evolution of Treatment - [382]
Pierre Z, Mattos JL. “Smell and the sinuses.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2026). PMID: 42219147 ↗
L5REVIEW_NARRATIVECited in: History and Evolution of Treatment - [383]
Mirza AA, Senan HA, Hernaiz-Leonardo JC et al.. “Advanced Age in Sinus Surgery: Diminished Symptom Gains but Enhanced Surgical Durability in Chronic Rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2025). PMID: 41085149 ↗
L2SR_OBSCited in: Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History - [384]
Fujieda S, Takabayashi T, Ohta N et al.. “Effectiveness and Safety of Dupilumab Monotherapy in Japanese Patients With Chronic Rhinosinusitis With Nasal Polyps.” The Laryngoscope (2025). PMID: 40884290 ↗
L4TRIAL_NONRANDOMCited in: Surgical Technique, Approaches and Perioperative Care, Prognosis and Natural History, Special Populations and Pregnancy - [385]
Gnanasekaran S, Jayaraj V, V B Y et al.. “Evaluating the efficacy of nasal irrigation in postoperative functional endoscopic sinus surgery patients: a systematic review and meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2024). PMID: 38492009 ↗
L1SR_OBSCited in: Surgical Technique, Approaches and Perioperative Care - [386]
Goyal VK, Spillinger A, Peterson EI et al.. “Odontogenic sinusitis publication trends from 1990 to 2019: a systematic review.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2021). PMID: 33609178 ↗
L2SR_OBSCited in: Surgical Technique, Approaches and Perioperative Care - [387]
Moon S, Lee M, Jung I et al.. “Oral Corticosteroids and Adverse Events in Chronic Rhinosinusitis With Nasal Polyps.” JAMA otolaryngology-- head & neck surgery (2026). PMID: 42241008 ↗
L3OTHERCited in: Surgical Technique, Approaches and Perioperative Care - [388]
Kalish LH, Arendts G, Sacks R et al.. “Topical steroids in chronic rhinosinusitis without polyps: a systematic review and meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2009). PMID: 19932837 ↗
L1SR_OBSCited in: Complications, Special Populations and Pregnancy - [389]
Haddad R, Khoueir N, Smaily H et al.. “Safety and Efficacy of the Draf IIb Procedure: A Systematic Review.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2021). PMID: 33820467 ↗
L2SR_OBSCited in: Complications, Prognosis and Natural History - [390]
Soler ZM, Jones R, Le P et al.. “Sino-Nasal outcome test-22 outcomes after sinus surgery: A systematic review and meta-analysis.” The Laryngoscope (2017). PMID: 29164622 ↗
L2SR_OBSCited in: Complications - [391]
Gill AS, Alt JA, Detwiller KY et al.. “Management paradigms for chronic rhinosinusitis in individuals with asthma: An evidence-based review with recommendations.” International forum of allergy & rhinology (2023). PMID: 36579899 ↗
L2SR_OBSCited in: Complications - [392]
Poetker DM, Jakubowski LA, Lal D et al.. “Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations.” International forum of allergy & rhinology (2012). PMID: 22887970 ↗
L2SR_OBSCited in: Complications - [393]
Pandrangi VC, Scott BL, Pailet J et al.. “Pain and Opioid Consumption Following Endoscopic Sinus Surgery: A Prospective Cohort Study.” The Laryngoscope (2021). PMID: 34843110 ↗
L2COHORTCited in: Complications - [394]
Keller JJ, Wu CS, Lin HC. “Chronic rhinosinusitis increased the risk of chronic periodontitis: a population-based matched-cohort study.” The Laryngoscope (2013). PMID: 23666605 ↗
L2COHORTCited in: Complications - [395]
Bogdanov V, Walliczek-Dworschak U, Whitcroft KL et al.. “Response to Glucocorticosteroids Predicts Olfactory Outcome After ESS in Chronic Rhinosinusitis.” The Laryngoscope (2019). PMID: 31373696 ↗
L2RCTCited in: Complications - [396]
Megow A, Alsuliman Y, Bouras G et al.. “Chitogel following endoscopic sinus surgery promotes a healthy microbiome and reduces postoperative infections.” International forum of allergy & rhinology (2022). PMID: 35319832 ↗
L1RCTCited in: Complications - [397]
McCormick JP, Suh JD, Yang HH et al.. “Triamcinolone-impregnated bioabsorbable middle meatus packing following endoscopic sinus surgery: A prospective randomized controlled trial.” International forum of allergy & rhinology (2022). PMID: 35019237 ↗
L1RCTCited in: Complications - [398]
Singhal D, Foreman A, Jervis-Bardy J et al.. “Staphylococcus aureus biofilms: Nemesis of endoscopic sinus surgery.” The Laryngoscope (2011). PMID: 21647904 ↗
L2TRIAL_NONRANDOMCited in: Complications - [399]
Huang S, Wu X, Huang Z et al.. “Middle turbinate preservation versus resection during endoscopic sinus surgery: a systematic review and meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 41466066 ↗
L2SR_OBSCited in: Complications - [400]
Han JK, Marple BF, Smith TL et al.. “Effect of steroid-releasing sinus implants on postoperative medical and surgical interventions: an efficacy meta-analysis.” International forum of allergy & rhinology (2012). PMID: 22550039 ↗
L1SR_OBSCited in: Complications - [401]
Bugten V, Nordgård S, Steinsvåg S. “Long-term effects of postoperative measures after sinus surgery.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2007). PMID: 17960410 ↗
L2RCTCited in: Complications - [402]
Cho KS, Kim SW, Kim JK et al.. “Efficacy of Rhino-Protect ointment after endoscopic sinus surgery: a prospective, randomized, multicenter study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2020). PMID: 32757038 ↗
L1RCTCited in: Complications - [403]
Husain S, Ramos JA, Karaf JHA et al.. “Efficacy of topical tranexamic acid to reduce bleeding in endoscopic sinus surgery for chronic rhinosinusitis with polyposis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2022). PMID: 35900386 ↗
L1RCTCited in: Complications - [404]
Daniel H, Valencia-Sanchez BA, Wadei H et al.. “Impact of Immunosuppressive Medications on Chronic Rhinosinusitis and Endoscopic Sinus Surgery in Transplant Recipients.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2026). PMID: 41774565 ↗
L2OTHERCited in: Complications - [405]
McCoul ED, Megwalu UC, Joe S et al.. “Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023). PMID: 35349383 ↗
L5OTHERCited in: Complications - [406]
Karadaghy OA, Peterson AM, Fox M et al.. “Creation of a Novel Preoperative Imaging Review Acronym to Aid in Revision Endoscopic Sinus Surgery.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2021). PMID: 34699279 ↗
L5REVIEW_NARRATIVECited in: Complications - [407]
Zawawi F, Shapiro AJ, Dell S et al.. “Otolaryngology Manifestations of Primary Ciliary Dyskinesia: A Multicenter Study.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2021). PMID: 34154450 ↗
L4OTHERCited in: Complications - [408]
Gill AS, Virani FR, Hwang JC et al.. “Preoperative Gabapentin Administration and Its Impact on Postoperative Opioid Requirement and Pain in Sinonasal Surgery.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2020). PMID: 32894993 ↗
L2OTHERCited in: Complications - [409]
Snidvongs K, Kalish L, Sacks R et al.. “Topical steroid for chronic rhinosinusitis without polyps.” The Cochrane database of systematic reviews (2011). PMID: 21833974 ↗
L1SR_OBSCited in: Complications - [410]
Leewannapasai W, Tangbumrungtham N, Sarsitthithum K et al.. “Efficacy of Local Bupivacaine Injection of Postoperative Pain in Endoscopic Sinus Surgery.” International forum of allergy & rhinology (2025). PMID: 41243874 ↗
L1RCTCited in: Complications - [411]
Tao X, Chen F, Sun Y et al.. “Prediction models for postoperative uncontrolled chronic rhinosinusitis in daily practice.” The Laryngoscope (2018). PMID: 30295929 ↗
L4OTHERCited in: Complications - [412]
Krings JG, Kallogjeri D, Wineland A et al.. “Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis.” The Laryngoscope (2013). PMID: 24122737 ↗
L2OTHERCited in: Complications - [413]
Stankiewicz JA, Lal D, Connor M et al.. “Complications in endoscopic sinus surgery for chronic rhinosinusitis: a 25-year experience.” The Laryngoscope (2011). PMID: 22086769 ↗
L4OTHERCited in: Complications - [414]
Toskala E, Kennedy DW. “Asthma risk factors.” International forum of allergy & rhinology (2015). PMID: 26335830 ↗
L5REVIEW_NARRATIVECited in: Complications - [415]
Du R, Jiao W, Ma J et al.. “Association between ambient temperature and chronic rhinosinusitis.” International forum of allergy & rhinology (2023). PMID: 36897288 ↗
L3OTHERCited in: Complications - [416]
Fischer JL, Gallagher TJ, Lin ME et al.. “Complications in Endoscopic Sinus Surgery: A TriNetX Network Analysis.” International forum of allergy & rhinology (2025). PMID: 40782144 ↗
L2OTHERCited in: Complications - [417]
Im YH, Stybayeva G, Hwang SH. “Efficacy of the Exhalation Delivery System With Fluticasone for Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.” The Annals of otology, rhinology, and laryngology (2025). PMID: 40616415 ↗
L1SR_OBSCited in: Complications - [418]
Kim DH, Jang DW, Hwang SH. “Efficacy of Additional (Selective) Vidian Neurectomy in Treating Chronic Rhinosinusitis with Nasal Polyp: A Systematic Review and Meta-Analysis.” ORL; journal for oto-rhino-laryngology and its related specialties (2025). PMID: 40300573 ↗
L2SR_OBSCited in: Complications - [419]
Saccardo T, Roccuzzo G, Tessari N et al.. “Early real-life outcomes of dupilumab and mepolizumab in patients with uncontrolled primary diffuse type 2 chronic rhinosinusitis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 41109883 ↗
L2OTHERCited in: Complications, Prognosis and Natural History, Special Populations and Pregnancy - [420]
Marco G, Arianna S, Domenico C et al.. “Efficacy of Dupilumab in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP): a multicentric real-life study.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2025). PMID: 40652138 ↗
L4OTHERCited in: Complications, Prognosis and Natural History - [421]
Le PT, Soler ZM, Jones R et al.. “Systematic Review and Meta-analysis of SNOT-22 Outcomes after Surgery for Chronic Rhinosinusitis with Nasal Polyposis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2018). PMID: 29712509 ↗
L2SR_OBSCited in: Prognosis and Natural History - [422]
Joe SA, Thambi R, Huang J. “A systematic review of the use of intranasal steroids in the treatment of chronic rhinosinusitis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2008). PMID: 18722209 ↗
L2SR_OBSCited in: Prognosis and Natural History - [423]
Mukerji SS, Pynnonen MA, Kim HM et al.. “Probiotics as adjunctive treatment for chronic rhinosinusitis: a randomized controlled trial.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2009). PMID: 19201289 ↗
L1RCTCited in: Prognosis and Natural History - [424]
Bhat AM, Heiland LD, Nguyen SA et al.. “Topical steroids for chronic rhinosinusitis without nasal polyps: A systematic review and meta-analysis.” International forum of allergy & rhinology (2024). PMID: 38787291 ↗
L1SR_OBSCited in: Prognosis and Natural History - [425]
Huang T, Zhou J, Yuan F et al.. “The percentage of controlled chronic rhinosinusitis after treatment: a systematic review and meta-analysis.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2023). PMID: 38108847 ↗
L2SR_OBSCited in: Prognosis and Natural History - [426]
Liao H, Qiu C, Luo Y et al.. “Safety and efficacy of anti-IL-5 monoclonal antibodies as second-line therapy for chronic rhinosinusitis with nasal polyps: a meta-analysis.” Frontiers in immunology (2026). PMID: 41983135 ↗
L1SR_OBSCited in: Prognosis and Natural History, Special Populations and Pregnancy - [427]
Pedersen CK, Backer V, Tidemandsen JE et al.. “Psychophysical Olfactory Outcomes After Biologic Therapy for Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review and Meta-Analysis.” Current allergy and asthma reports (2026). PMID: 41903052 ↗
L2SR_OBSCited in: Prognosis and Natural History, Special Populations and Pregnancy - [428]
Zhu X, Liu K, Shi H et al.. “The effects of various drug irrigation in post operative endoscopic sinus surgery patients: A systematic review and network meta-analysis.” American journal of otolaryngology (2026). PMID: 41965160 ↗
L1SR_OBSCited in: Prognosis and Natural History - [429]
Xu S, Cai S, Zhao Y et al.. “Comparative Efficacy of Seven Biologics for Chronic Rhinosinusitis With Nasal Polyps: A Network Meta-Analysis.” Allergy (2026). PMID: 41999554 ↗
L1SR_OBSCited in: Prognosis and Natural History - [430]
Huang S, Li X, Wu H et al.. “Vitamin D Status and Supplementation in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2026). PMID: 41774579 ↗
L3SR_OBSCited in: Special Populations and Pregnancy - [431]
Rahavi-Ezabadi S, Zhou S, Lee SE et al.. “Biologic Therapy in Pediatric Chronic Rhinosinusitis: A Systematic Review.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2024). PMID: 38488239 ↗
L2SR_OBSCited in: Special Populations and Pregnancy - [432]
Papacharalampous GX, Constantinidis J, Fotiadis G et al.. “Chronic rhinosinusitis with nasal polyps (CRSwNP) treated with omalizumab, dupilumab, or mepolizumab: A systematic review of the current knowledge towards an attempt to compare agents' efficacy.” International forum of allergy & rhinology (2023). PMID: 37394893 ↗
L2SR_OBSCited in: Special Populations and Pregnancy - [433]
Pynnonen MA, Venkatraman G, Davis GE. “Macrolide therapy for chronic rhinosinusitis: a meta-analysis.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2013). PMID: 23314162 ↗
L2SR_OBSCited in: Special Populations and Pregnancy - [434]
Karanth TK, Karanth VKLK, Ward BK et al.. “Medical interventions for chronic rhinosinusitis in cystic fibrosis.” The Cochrane database of systematic reviews (2022). PMID: 35390177 ↗
L1SR_OBSCited in: Special Populations and Pregnancy - [435]
Mari PV, Carriera L, Saviano A et al.. “Impact of IL-4/IL-13 Blockade with Dupilumab on the Microbiome in Type 2 Inflammatory Diseases: A Systematic Review.” Current allergy and asthma reports (2026). PMID: 42142274 ↗
L2SR_OBSCited in: Special Populations and Pregnancy - [436]
Annadata VS, Huynh PP, Liang J. “Arthritis-Related Adverse Reactions of Dupilumab in Treatment of Chronic Rhinosinusitis.” The Laryngoscope (2025). PMID: 40673627 ↗
L4OTHERCited in: Special Populations and Pregnancy - [437]
Whong Z, Malik A, Calder AN et al.. “COVID-19 Infection Increases the Risk of Subsequent Diagnosis of Chronic Rhinosinusitis.” The Laryngoscope (2026). PMID: 41699192 ↗
L2OTHERCited in: Prevention, Screening and Surveillance - [438]
Duffy AN, Alapati R, Chitguppi C et al.. “Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis.” The Laryngoscope (2023). PMID: 37159280 ↗
L3OTHERCited in: Prevention, Screening and Surveillance - [439]
Silva BRC, Tyler MA, Ma Y et al.. “Incidence of hypocortisolism with long-term budesonide irrigation for chronic rhinosinusitis.” International forum of allergy & rhinology (2023). PMID: 37389470 ↗
L2OTHERCited in: Prevention, Screening and Surveillance - [440]
Patel NN, Kohanski MA, Maina IW et al.. “Sentinels at the wall: epithelial-derived cytokines serve as triggers of upper airway type 2 inflammation.” International forum of allergy & rhinology (2018). PMID: 30260580 ↗
L5REVIEW_NARRATIVECited in: Prevention, Screening and Surveillance - [441]
Nieman CL, Navas-Acien A, Lin SY et al.. “Physician screening and recommendations on secondhand smoke in chronic rhinosinusitis patients.” International forum of allergy & rhinology (2013). PMID: 24375993 ↗
L3OTHERCited in: Prevention, Screening and Surveillance - [442]
Bareiss AK, Kattar N, Tivis R et al.. “Health-care utilization for sinusitis after pneumococcal vaccination in patients with low antibody titers.” International forum of allergy & rhinology (2022). PMID: 34962358 ↗
L2OTHERCited in: Prevention, Screening and Surveillance - [443]
Manji J, Singh G, Okpaleke C et al.. “Safety of long-term intranasal budesonide delivered via the mucosal atomization device for chronic rhinosinusitis.” International forum of allergy & rhinology (2017). PMID: 28151588 ↗
L2OTHERCited in: Prevention, Screening and Surveillance - [444]
Wu EL, Riley CA, Hsieh MC et al.. “Chronic sinonasal tract inflammation as a precursor to nasopharyngeal carcinoma and sinonasal malignancy in the United States.” International forum of allergy & rhinology (2017). PMID: 28549211 ↗
L3OTHERCited in: Prevention, Screening and Surveillance - [445]
Daloiso A, Mondello T, Boaria F et al.. “Pott's Puffy Tumor in Young Age: A Systematic Review and Our Experience.” Journal of clinical medicine (2024). PMID: 39518567 ↗
L4SR_OBSCited in: Prevention, Screening and Surveillance - [446]
Nanayakkara JP, Igwe C, Roberts D et al.. “The impact of mental health on chronic rhinosinusitis symptom scores.” European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2012). PMID: 23095946 ↗
L4OTHERCited in: Prevention, Screening and Surveillance - [447]
Mencarelli L, Moi L, Dewarrat N et al.. “Eosinophilic Granulomatosis with Polyangiitis after mRNA-1273 SARS-CoV-2 Vaccine.” Vaccines (2023). PMID: 37631903 ↗
L4CASE_REPORTCited in: Prevention, Screening and Surveillance - [448]
Guo T, Luo P, Jia G et al.. “A Risk Factor Atlas for Allergy-Related Airway Diseases: Evidence From Multi-Biobank Genetic Study.” Allergy, asthma & immunology research (2026). PMID: 41914530 ↗
L2OTHERCited in: Prevention, Screening and Surveillance - [449]
Olbrich H, Preuß SL, Kridin K et al.. “COVID-19 infection raises respiratory type 2 inflammatory disease risk, whereas vaccination is protective.” The Journal of allergy and clinical immunology (2025). PMID: 40812431 ↗
L2OTHERCited in: Prevention, Screening and Surveillance - [450]
Singh A, Zeig-Owens R, Webber MP et al.. “Self-reported chronic rhinosinusitis diagnoses and symptoms in World Trade Center-exposed and non-World Trade Center-exposed United States firefighters.” Preventive medicine (2024). PMID: 39740731 ↗
L2OTHERCited in: Prevention, Screening and Surveillance