Novel findings in immunopathophysiology of chronic rhinosinusitis and their role in a model of precision medicine.

Xu, Xinni; Ong, Yew Kwang; Wang, De Yun

Our understanding of the pathophysiology of chronic rhinosinusitis (CRS) is continuously evolving. The traditional description of CRS in terms of two phenotypes based on the presence or absence of nasal polyps belies the underlying intricate immunopathophysiological processes responsible for this condition. CRS is being increasingly recognised as a disease spectrum encompassing a range of inflammatory states in the sinonasal cavity, with non-Type 2 inflammatory disease on one end, Type 2 inflammatory, eosinophil-heavy disease on the other, and an overlap of both in different proportions in between. An abundance in research on the immune mechanisms of CRS has revealed various new endotypes that hold promise as biomarkers for the development of targeted therapies in severe, uncontrolled CRS. The introduction of precision medicine to manage this chronic, complex condition is a step forward in providing individualised care for all patients with CRS. In this review, the latest research on the pathophysiology of CRS with a focus on potential novel biomarkers and treatment options over the last two years are summarised and integrated into a suggested model of precision medicine in CRS.