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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 defined by ≥12 weeks of sinonasal inflammation; classify by phenotype (polyps) and endotype (type 2 vs non-type 2)
- ▸Disease control per EPOS: controlled, partially controlled, uncontrolled
CRS is chronic inflammation of sinonasal mucosa lasting ≥12 weeks [5]A1c[19]A1c. Anatomically centered on the osteomeatal complex (maxillary sinus ostium, ethmoid infundibulum, middle meatus) [17]D5. Classification is dual: phenotype (CRSwNP vs CRSsNP) and endotype (type 2 vs non-type 2) [5]A1c[17]D5[19]A1c. EPOS classification includes primary diffuse, primary local, secondary CRS (e.g., CF, PCD) [14]D5[17]D5. Disease control is categorized as controlled, partially controlled, or uncontrolled [14]D5. Prevalence is 18.8-23.3 per 1000, incidence 2.5 per 1000/year [35]B2b. Underutilization of intranasal steroids is a quality gap [40]B2b. 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
- ▸Type 2 inflammation (IL-4, IL-5, IL-13) drives CRSwNP; non-type 2 (Th1/Th17) drives CRSsNP
- ▸S. aureus superantigens and biofilms are key contributors to severity and treatment resistance
CRS driven by distinct inflammatory pathways: type 2 (IL-4, IL-5, IL-13, IgE) dominates CRSwNP; non-type 2 (Th1/Th17, IFN-γ, IL-17) is associated with CRSsNP [17]D5[50]A1a. Epithelial barrier dysfunction releases alarmins (TSLP, IL-25, IL-33) activating ILC2s and Th2 cells [50]A1a[87]D5. Microbial dysbiosis: S. aureus superantigens increase odds of CRSwNP (OR 12.07) [54]B3a; biofilms drive treatment resistance [69]D5[87]D5. Causal risk factors: smoking (OR 1.15), asthma (OR 1.45), allergic rhinitis (OR 4.77), BMI (OR 1.05) [82]B2c. Tissue remodeling involves periostin, MMP-9, and NLRP3 inflammasome [52]D5[67]D5[84]D5. The immune hyperresponsiveness hypothesis posits dysregulated response to commensal microbes [72]B3b. 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 management strategies targeting neutrophilic or mixed pathways.
| 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 |
Epidemiology, Etiology and Risk Factors
- ▸Obesity (OR 1.33), asthma (OR 1.45), and smoking (OR 1.15) are major modifiable risk factors
- ▸Bidirectional relationship with depression and anxiety: CRS increases risk and vice versa
CRS prevalence is 4.3-10.4% in adults, incidence 2.5 per 1000/year [35]B2b[112]B2a. Female sex increases odds of CRSsNP (OR 1.44 age <60) but decreases CRSwNP (OR 0.63) [114]C4. Allergic fungal rhinosinusitis disproportionately affects Black patients (58.0%) [93]A1a. Key modifiable risk factors: obesity (OR 1.33) [48]A1a, asthma (OR 1.45) [82]B2c, GERD (OR 1.36) [127]B2b, smoking (causal OR 1.15) [82]B2c. Bidirectional associations with depression (HR 1.40) and anxiety (HR 2.79) [113]B2b. CRS increases risk of new-onset asthma (OR 1.74), bronchiectasis (OR 1.87), COPD (OR 1.73), OSA (OR 1.91) [105]B2b. Pediatric CRS linked to adenoiditis and immune deficiency [66]D5. Pearl: Female sex predisposes to CRSsNP; male sex to CRSwNP; AFRS disproportionately affects Black and underinsured patients.
| Factor | Odds Ratio / Relative Risk | Evidence Level |
|---|---|---|
| Sibling with pediatric CRS | HR 57.5 (p<10⁻⁸) [122]B2b | 2b |
| 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 |
Clinical Presentation
- ▸CRSsNP: more facial pain; CRSwNP: more olfactory loss and polyp recurrence
- ▸Unilateral symptoms: consider odontogenic, fungal, or autoimmune causes
Cardinal symptoms: nasal obstruction, mucopurulent discharge, facial pain/pressure, olfactory disturbance for ≥12 weeks [133]A1c. Facial pain more prominent in CRSsNP (56.4% moderate/severe) vs CRSwNP (29.8%) [91]A1a. Olfactory dysfunction is underappreciated: prevalence 30-78% on validated testing [95]A1a; worse in CRSwNP (mean TDI difference 8.7 points) [159]C4. Taste dysfunction affects 28-34% [164]C4[2]B2a. Sleep disturbance and depression are common: 24.4% screen positive on PHQ-2 [158]B2b. Phenotypic variants: AERD (triad of CRSwNP, asthma, NSAID hypersensitivity) [138]B2a[152]D5; AFRS (young adults, mean age 27.7, male predominance, eosinophilic mucin) [167]C4; odontogenic sinusitis (unilateral, foul odor, dental pathology) [20]A1c[163]B3b; CF-CRS (polyps in 50-60%) [53]D5[155]B2a; GPA (nasal crusting, septal perforation, saddle-nose, PR3-ANCA positive) [156]C4. Red flags: unilateral symptoms, orbital signs, intracranial pressure elevation [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.
| 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 |
| Aspirin-exacerbated respiratory disease (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; subglottic stenosis; PR3-ANCA positive in >85% | Destructive lesions predict renal involvement; misdiagnosis as CRS is common [156]C4 |
Audiologic, Vestibular and Endoscopic Assessment
- ▸Nasal endoscopy is essential for diagnosis and monitoring; use MLK score for serial assessment
- ▸Endoscopic scores correlate weakly with patient-reported outcomes; depression confounds
Diagnostic nasal endoscopy is the cornerstone, with sensitivity 0.87 and specificity 0.63 against CT [168]C4. Endoscopic findings: polyps, mucopurulent discharge, mucosal edema, obstruction of middle meatus [133]A1c[135]A1c. Modified Lund-Kennedy (MLK) score (grades polyps, edema, discharge, 0-2 each) has highest reliability and correlates with SNOT-22 symptom subscore [160]B2b. Nasal Polyp Score (NPS) 0-8 is primary endpoint in biologic trials; dupilumab improved NPS by -2.25 vs omalizumab at 24 weeks [179]A1b. Olfactory Cleft Endoscopy Scale (OCES) predicts retronasal olfaction [180]C4. Endoscopic scores correlate weakly with quality of life; depression confounds patient-reported outcomes [183]C4[158]B2b. Audiologic assessment: tympanometry indicated when otitis media with effusion suspected; 22.8% of severe CRSwNP have pathological tympanometry [120]A1b. Biologic therapy (mepolizumab, dupilumab) improves ear symptoms [120]A1b[170]C4. Vestibular assessment not routine; dizziness warrants alternative diagnoses. 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
- ▸CT (Lund-Mackay ≥4) is diagnostic but correlates weakly with symptoms; endoscopy is preferred first-line
- ▸Blood eosinophil count ≥0.16×10⁹/L is a strong predictor of eosinophilic CRS
CT is gold-standard imaging: Lund-Mackay score (LMS) ≥4 confirms disease [208]B3b[217]B2b. Sensitivity 0.90, specificity 0.50 against histopathology [168]C4. CT correlates weakly with symptoms (r=0.434 with SNOT-22) [193]B2a. MRI reserved for complications or unilateral disease [206]B2a. Endoscopy has high sensitivity (0.87), moderate specificity (0.63) [168]C4. Tissue biopsy: ≥70 eosinophils/HPF is gold-standard for eosinophilic CRS [221]B3b[222]B3b; systemic steroids reduce count (mean difference -36.57 cells/HPF) [224]B2a. Preoperative steroids should be withheld if biopsy planned. Laboratory studies: blood eosinophil count ≥0.16×10⁹/L or ≥2.05% predicts ECRS (sensitivity 84.9%, specificity 84.4%) [230]C4; total IgE elevated in AFRS [219]B3b; FeNO higher in ECRS (mean difference 32.21 ppb) [207]B3a; c-ANCA for GPA [156]C4; CFTR analysis for CF [194]B2a; nasal NO for PCD [151]D5. Diagnostic algorithm: Step 1: confirm objective inflammation (endoscopy or CT). Step 2: classify by polyp presence. Step 3: assess endotype (blood eosinophils, IgE, FeNO). Step 4: MRI for asymmetric disease. Step 5: ANCA for concerning features. Step 6: test for PCD/CF in children or adults with recurrent infections [151]D5[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.
| 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 male infertility, 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 |
Severity, Staging and Risk Stratification
- ▸EPOS 2020 uncontrolled disease: ≥3 criteria (symptoms, rescue meds, endoscopic findings) in prior month
- ▸Polyp recurrence after ESS: 35-40% at 18 months; prior ESS doubles risk
Lund-Mackay CT score (0-24) is most widely used radiographic staging, but correlates weakly with symptoms (r=0.434 with SNOT-22) [193]B2a. Modified Lund-Kennedy (MLK) endoscopic score has highest reliability and correlates with SNOT-22 symptom subscore [160]B2b. Nasal Polyp Score (NPS) 0-8 is primary endpoint for biologics; dupilumab shows mean difference -3.1 vs placebo at 24 weeks [233]A1b. SNOT-22 (0-110): clinically meaningful change ≥8.9 points [232]B2b. EPOS 2020 disease control criteria: uncontrolled if ≥3 of following in prior month: (1) nasal blockage/rhinorrhea/facial pain/smell loss/sleep disturbance; (2) rescue medication use in last 6 months; (3) mucosal disease on endoscopy [254]B3b. 40% of CRS patients meet uncontrolled criteria; mucus EDN level is independent predictor (OR 1.323) [254]B3b. Risk factors: asthma, OSA, obesity, blood eosinophils >0.16×10⁹/L, TAS2R38 polymorphisms [44]A1a[242]B3b[238]B3b[12]B3b[230]C4. Polyp recurrence after ESS: 35% at 6 months, 40% at 18 months; prior ESS (OR 2.6) and worse preoperative polyposis (OR 1.4) predict recurrence [121]B2b. Smoking cessation improves symptoms over 10-20 years [240]C4. 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.
| 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 |
Acute and Emergency Management
- ▸Pott's puffy tumor: forehead swelling, fever, headache; intracranial involvement in 38.1%
- ▸Uncomplicated AECRS: watchful waiting first; amoxicillin ± clavulanate if antibiotics needed
AECRS: transient worsening of symptoms returning to baseline [26]C4. Common pathogens: S. aureus (MSSA 22.5%), H. influenzae (11.9%) [126]B2a. Emergency presentations: orbital complications (proptosis, ophthalmoplegia, vision loss); Pott's puffy tumor (forehead swelling, fever, headache; intracranial involvement in 38.1%) [279]C4; intracranial extension (altered mental status, focal deficits). Obtain contrast-enhanced CT or MRI. Empiric antibiotics for Pott's puffy: cephalosporin, metronidazole, nafcillin; duration ~61 days [279]C4. Surgical intervention required in 87.3% of Pott's puffy cases [279]C4. For uncomplicated AECRS: watchful waiting is initial therapy; if antibiotics needed, amoxicillin ± clavulanate for 5-10 days [133]A1c[135]A1c. Intranasal corticosteroids and large-volume saline irrigation (≥150 mL) improve symptoms [199]A1a[201]A1a. Culture-directed antibiotics if no improvement in 7 days [282]C4. Avoid systemic antifungals and topical amphotericin B (no benefit, hepatotoxicity risk) [202]A1a. 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)
- ▸Biologics (dupilumab, tezepelumab, mepolizumab) are effective for severe CRSwNP; macrolides show no benefit
- ▸ESS improves QoL significantly; recurrence common (35-40% at 18 months); perioperative biologics may help
Surgery considered when patients have subtypes least likely to benefit from continued medical therapy: CRSwNP, polyps with bony erosion, eosinophilic mucin, fungal balls [134]A1c. No predefined medical therapy duration required before surgery [134]A1c. Medical options: topical corticosteroids (first-line; high-volume steroid irrigations more effective than sprays) [292]D5[324]D5; saline irrigation improves QoL (RSDI MD 13.5 points) [201]A1a. Biologics for severe uncontrolled CRSwNP: dupilumab ranked highest in network meta-analysis (NPS MD -1.85, SNOT-22 MD -12.56) [291]A1a; tezepelumab comparable (NPS and NCS) with lower surgery rate (0.5% vs 22.1%; HR 0.02) [143]A1b[308]A1a; mepolizumab improved SNOT-22 by -35.3 points at 12 months [330]B2b; depemokimab (twice-yearly) reduced NPS (integrated treatment difference -0.7) [294]A1b. Macrolides: MACRO trial showed no benefit over placebo for SNOT-22 [295]A1b. Oral corticosteroids: reduce polyp size but no benefit in CRSsNP after ESS [205]A1a[140]A1b. Topical antibiotics not recommended routinely; antifungals no benefit [202]A1a[288]D5. ESS improves SNOT-22 with large effect sizes (Cohen's d >1.0) [314]B2b. Polyp recurrence after ESS: 35% at 6 months, 40% at 18 months [121]B2b. Revision rates vary (mean 10.6%) [313]B2b. Perioperative dupilumab improves olfactory outcomes [104]A1b. 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
- ▸ESS has demonstrated clinical effectiveness for medically refractory CRS, whereas clarithromycin was no better than placebo in the MACRO trial. [363]
- ▸Mepolizumab reduces repeat-surgery risk and improves polyp, symptom, smell, and quality-of-life outcomes in previously operated CRSwNP. [451]
- ▸Biologic selection and switching are increasingly guided by response criteria, comorbid disease, and longitudinal outcomes rather than by a single baseline marker. [377] [457]
- ▸Cumulative corticosteroid exposure should be actively assessed because adrenal and skeletal complications are relevant in CRS with coexisting airway disease. [455]
- ▸Persistent, unilateral, paediatric, cystic-fibrosis-associated, or systemic-disease-associated CRS requires evaluation for a specific underlying cause. [151] [375] [458] [461] [463]
From empiric medical therapy to evidence-based escalation
Treatment of chronic rhinosinusitis (CRS) has progressively shifted from predominantly symptom-directed medical care toward phenotype-specific, multimodal management. Recent evidence from the MACRO randomised controlled trial indicates that endoscopic sinus surgery (ESS) was clinically effective for appropriately selected, medically refractory patients, whereas clarithromycin was no better than placebo; qualitative interviews nevertheless identified implementation barriers affecting acceptance of these results. [363]D5 ESS can also produce substantial improvements in olfaction and sinonasal quality of life in chronic rhinosinusitis with nasal polyps (CRSwNP): in a prospective study, mean SNOT-22 scores fell from 57 ± 20 preoperatively to 15 ± 14 at 3 months, although the mean score increased to 25 ± 19 by 6 months. [462]C
The modern role of surgery is therefore increasingly complementary rather than necessarily definitive. In CRSwNP, the need for repeated surgery has encouraged development of long-term anti-inflammatory and biologic strategies. In the phase III SYNAPSE programme, mepolizumab, administered every 4 weeks with standard care for 52 weeks, reduced the need for repeat surgery and improved endoscopic polyp scores, nasal obstruction, loss of smell, overall symptoms, and SNOT-22 outcomes in patients with one or more previous nasal-polyp surgeries. [451] Real-world prospective data similarly report high response rates to dupilumab and mepolizumab in severe CRSwNP, with response assessed using the EPOS/EUFOREA 2023 framework and incorporating polyp burden, SNOT-22, symptoms, and olfaction. [377]B2b
Emergence of biologic treatment
Biologics have expanded treatment beyond repeated systemic corticosteroids and surgery for severe, uncontrolled CRSwNP. Omalizumab has also shown benefit in a previously less well-defined group: adults with moderate CRSwNP, mild-to-moderate IgE-mediated asthma, and no previous sinus surgery. In a 59-patient randomised open-label study followed for 12 months, omalizumab plus standard therapy was compared with standard therapy alone, with nasal-polyp score as the primary outcome and additional assessment of nasal obstruction, asthma control, exacerbations, and systemic corticosteroid use. [452]
Treatment selection is evolving from a one-biologic-fits-all approach. A multicentre prospective cohort found predictors of response to dupilumab or mepolizumab, although the evidence remains observational and guidance on choosing between agents is limited. [377]B2b Conversely, a tertiary-centre retrospective series found that 18% of 400 biologic-treated patients switched biologics after a mean of 38 months, highlighting incomplete response or loss of response as practical issues in long-term care. [457] Mepolizumab treatment has also been associated with changes in systemic type 2 and non-type 2 cytokine profiles in patients with severe eosinophilic asthma, CRSwNP, or eosinophilic granulomatosis with polyangiitis, supporting—but not by itself proving—the value of biomarker-informed treatment. [456]
Steroid stewardship and treatment delivery
The biologic era has also emphasised cumulative corticosteroid toxicity. Among patients with CRSwNP and/or global airway disease referred for biologic assessment, investigators measured systemic, inhaled, and nasal corticosteroid exposure alongside adrenal and bone outcomes, including secondary adrenal insufficiency and osteopenia or osteoporosis. [455] These findings support reducing avoidable systemic exposure while maintaining effective topical therapy. Adherence to intranasal corticosteroids remains a treatment determinant: a crossover trial evaluated a metered-dose-inhaler adaptor intended to reduce post-nasal drip and nasal irritation in allergic rhinitis and postoperative CRS, symptoms commonly associated with poor compliance. [453]
Patient-centred treatment has become more prominent. Psychological dysfunction can influence the relationship between symptoms and computed-tomography findings and affects outcomes after ESS; a prospective cohort followed SNOT-22 outcomes for 5 years to examine this effect. [454] Treatment planning should therefore incorporate symptom burden, quality of life, psychological factors, objective disease, and comorbid airway disease rather than relying on imaging alone. [454]
Precision care for associated and secondary CRS
The historical progression toward personalised care includes recognition of disease-specific mechanisms and causes. In eosinophilic CRSwNP, spatial transcriptomic and single-cell analyses identified subepithelial ALOX15-positive macrophage niches and an ALOX15–ERK–CCL13 pathway associated with eosinophil recruitment, suggesting future macrophage- or pathway-directed therapies beyond currently available biologics. [460]C Environmental prevention is also gaining attention: long-term exposure to traffic- and industry-related pollutants, including nitrogen dioxide and benzene, was investigated in relation to CRS risk and sinonasal cytokine expression. [71]B3b
Unilateral CRS requires aetiological assessment before routine escalation. A prospective surgical study found dental-origin pathology and dentally related anatomical variants among patients undergoing ESS for medically refractory unilateral CRS, supporting multidisciplinary dental evaluation when odontogenic disease is possible. [461]C In cystic fibrosis, revision ESS is more frequent and occurs sooner than in patients without cystic fibrosis; retrospective data are examining whether elexacaftor/tezacaftor/ivacaftor triple-modulator therapy reduces the likelihood of revision surgery. [458]
In children, treatment evolution is linked to earlier identification of persistent disease and underlying disorders. A 5-year prospective study of preschool children evaluated clinical and multi-omics predictors of persistent CRS and house-dust-mite allergic rhinitis. [375]B2b Primary ciliary dyskinesia should be considered when CRS occurs with progressive lung disease, recurrent otitis, laterality defects, or reduced fertility; the joint ERS/ATS diagnostic guideline emphasises that diagnosis requires multiple tests because clinical presentation is heterogeneous. [151]D5 CRS may also accompany systemic vasculitis, including eosinophilic granulomatosis with polyangiitis, and respiratory phenotypes can evolve over time. [463]C
Finally, ultra-long-acting biologics such as depemokimab have demonstrated twice-yearly dosing and sustained efficacy in type 2 asthma, but the cited evidence is asthma-specific and should not be interpreted as direct evidence for CRS treatment. [362]A1a Real-world dupilumab studies in severe type 2 asthma likewise support its airway-wide role, but remain indirect evidence when treating CRS itself. [459] [376]B2b
| Treatment phase | Current evidence and implications |
|---|---|
| Medical therapy and antibiotics | Clarithromycin was no better than placebo in MACRO; topical corticosteroid delivery and adherence remain important. [363]D5 [453] |
| ESS | Effective in appropriately selected medically refractory CRS; improves symptoms, quality of life, and often olfaction. [363]D5 [462]C |
| Biologics | Mepolizumab, dupilumab, and omalizumab support phenotype- and severity-based escalation, including selected moderate disease. [451] [452] [377]B2b |
| Long-term disease control | Monitor biologic response, switching, cumulative corticosteroid toxicity, psychological factors, and comorbid airway disease. [455] [454] [457] |
| Precision and aetiological care | Address PCD, cystic fibrosis, dental disease, pollutants, allergic disease, and systemic vasculitis when clinically indicated. [151]D5 [375]B2b [458] [461]C [71]B3b [463]C |
Surgical Technique, Approaches and Perioperative Care
- ▸Consider ESS for medically refractory CRSwNP; severe trial-defined disease included **SNOT-22 ≥30**, bilateral NPS **≥4**, and modified Lund–Mackay score **≥14**. [466]
- ▸Choose limited versus full ESS according to disease distribution and postoperative treatment access; randomized comparative evidence is emerging. [466]
- ▸Nasalisation may be considered in selected severe CRSwNP, but existing comparative evidence is retrospective and confounded by baseline severity. [504]
- ▸Crushing and resection are both reasonable concha-bullosa adjuncts to FESS based on current randomized evidence. [465]
- ▸Long-term endoscopic surveillance and topical anti-inflammatory therapy remain central because recurrence can occur within **1 year** and over follow-up extending to **15 years**. [469,502,503]
- ▸Biologics, including dupilumab, may be used before or after ESS; prior surgery does not preclude biologic response. [473,499]
Indications and treatment selection
Endoscopic sinus surgery (ESS) remains an option for adults with chronic rhinosinusitis with nasal polyps (CRSwNP) whose disease remains uncontrolled despite appropriate local treatment, particularly when symptoms, endoscopic polyp burden, and imaging abnormalities are substantial. In the AirGOs Operative randomized trial, eligibility required a SNOT-22 score ≥30, bilateral nasal polyp score (NPS) ≥4, modified Lund–Mackay score ≥14, and previous surgery or systemic medication for CRSwNP. [466] Biologics and ESS are both established treatments for refractory CRSwNP; a 2026 systematic review identified 10 phase-3 biologic randomized trials and 2 pragmatic ESS trials, but emphasized that direct biologic–ESS comparisons remain limited and that indirect comparisons should not be interpreted as equivalent to head-to-head evidence. [499]
Biologic use has increased since regulatory approvals beginning in 2019, while claims-data analyses showed a corresponding decline in ESS utilization; these temporal associations do not establish that biologics are superior to surgery or that surgery is no longer indicated. [506] Prior ESS did not eliminate subsequent response to dupilumab in a real-world cohort, supporting individualized sequencing or combination treatment when postoperative disease remains uncontrolled. [473]
Extent and technical approach
For CRSwNP, the optimal extent of ESS remains unsettled. The AirGOs Operative randomized trial directly compared full with limited functional ESS in patients with severe, previously treated disease; its primary outcome was change in SNOT-22 at 12 and 24 months. [466] Until complete trial results and subgroup data are available, the extent of surgery should be tailored to disease distribution, anatomy, prior procedures, postoperative access requirements, and the need for topical therapy rather than assumed to be uniformly radical. [466]
A 10-year retrospective comparison of functional ESS and nasalisation (radical ethmoidectomy) included 480 procedures—374 functional ESS and 106 nasalisation procedures. Patients selected for nasalisation had more severe baseline disease, including worse NOSE scores, olfaction-related visual-analogue scores, and Lildholdt polyp scores, limiting direct comparison. Outcomes were assessed at 1, 3, 6, 12, and 24 months; the study therefore supports consideration of more extensive surgery in selected severe cases but does not provide randomized evidence that nasalisation should replace functional ESS. [504]
When a concha bullosa obstructs access or contributes to disease, either crushing or resection can be used as an adjunct to FESS. In a prospective randomized study, 62 patients underwent one of these approaches and 52 completed 1-year follow-up; both groups were assessed with SNOT-22 and endoscopic outcomes including synechiae and middle-meatus access. [465] The available evidence supports both techniques as reasonable options, with selection based on anatomy, access, mucosal preservation, and surgeon expertise rather than a universal preference. [465]
Postoperative topical treatment and surveillance
Postoperative management should prioritize sustained topical anti-inflammatory delivery and endoscopic surveillance. A prospective randomized study of 138 patients with CRSwNP compared budesonide nasal spray, combined spray plus budesonide nasal drops, and spray plus oral prednisone over a 2-week treatment period, using VAS, SNOT-22, and endoscopic polyp scores as outcomes. [500] These data directly address delivery method and short-course treatment, but the reported intervention period does not establish the optimal long-term regimen; clinicians should therefore individualize treatment duration and delivery according to mucosal healing, access, disease severity, and adverse effects. [500]
Recurrence is common enough to require longitudinal monitoring. A retrospective cohort of 543 ESS patients evaluated recurrence prediction using age, sex, smoking, asthma, NSAID hypersensitivity, symptom duration, blood eosinophils, NPS, postoperative discharge-edema score, and Lund–Mackay score, using both discrete-time and Cox models to estimate recurrence risk through 15 years. [502] A separate internally validated nomogram study included 404 patients with CRSwNP and defined recurrence as the first postoperative endoscopic detection of polyps within 2 years. [503] These models may support risk-stratified follow-up, but their retrospective and, for the nomogram, internally validated designs require external validation before routine clinical use. [502][503]
Tissue-based findings suggest that recurrence is not explained solely by classic type-2 inflammation. In a cohort of 91 patients, rapid recurrence was defined as recurrence within 1 year, whereas slow or absent recurrence meant more than 2 years without recurrence; proteomic and ELISA analyses identified an innate-myeloid inflammatory axis associated with recurrence. [469] This remains prognostic research rather than a validated operative-selection test. [469]
Perioperative and special-population considerations
Postoperative pain management should be multimodal and individualized. In a retrospective cohort of 135 FESS patients, low-dose esketamine at 0.2 or 0.3 mg/kg was compared with saline after propensity-score matching; the primary endpoint was 24-hour postoperative pain, with sleep, emotional status, hemodynamics, and adverse events as secondary outcomes. [505] Because the evidence is retrospective, esketamine should not be considered routine solely on this basis. [505]
Microbiome changes should not currently dictate antibiotic or surgical strategy. A prospective pilot study collected middle-meatus samples during ESS and approximately 6 weeks later in patients with CRS with and without polyps; only 22 paired samples were available for final analysis. [501]C The small sample and pilot design limit clinical application. [501]C
Patients with cystic fibrosis have higher revision-ESS rates and earlier revision than patients without cystic fibrosis; a retrospective study evaluated whether elexacaftor/tezacaftor/ivacaftor therapy was associated with reduced revision surgery in 53 patients undergoing FESS, including 32 treated with triple-modulator therapy. [458] In children with cystic-fibrosis-associated CRS, a separate retrospective study evaluated 12-month clinical, endoscopic, radiologic, functional, and laboratory outcomes after elexacaftor/tezacaftor/ivacaftor, with atopy and TAS2R38 genotype also examined. [485]C These therapies may alter surgical timing and revision risk, but current evidence remains observational. [458][485]C
BMI, glycemic status, and vitamin D are additional potential modifiers of postoperative outcomes. A 5-year longitudinal cohort examined BMI in relation to baseline symptoms, postoperative SNOT-22 trajectories, revision surgery, and biologic use. [508] A multicenter study evaluated normoglycemic and dysglycemic patients, with or without antidiabetic-agent use, after ESS for CRSwNP and followed recurrence for at least 3 years. [507] A systematic review and meta-analysis assessed vitamin D status and supplementation in relation to CRS severity, recurrence, quality of life, inflammatory markers, and postoperative outcomes. [464] These factors may inform optimization and counseling, but the cited observational and synthesis-level evidence does not justify a universal perioperative supplement or surgical modification. [464][507][508]
| Clinical issue | Evidence-informed approach | Evidence |
|---|---|---|
| ESS candidacy | Consider after uncontrolled disease despite local treatment; severe trial criteria included SNOT-22 ≥30, bilateral NPS ≥4, and modified Lund–Mackay ≥14. | [466] |
| Extent of surgery | Individualize limited versus full ESS; consider nasalisation selectively in severe disease. | [466][504] |
| Concha bullosa | Crushing or resection may be selected according to anatomy and access. | [465] |
| Topical therapy | Budesonide spray, drops, and short systemic-steroid strategies have been prospectively compared; long-term regimen remains individualized. | [500] |
| Recurrence surveillance | Use serial endoscopy and consider clinical risk factors; prediction models require further validation. | [469][502][503] |
| Special populations | Account for cystic fibrosis, metabolic status, BMI, and potential biologic therapy when planning follow-up. | [458][464][485]C[507][508] |
Complications
- ▸CRS complications include persistent sinonasal symptoms, olfactory dysfunction, impaired quality of life, treatment burden, and recurrent disease after surgery.[417][475][479][480]
- ▸Evaluate recurrent otitis, laterality defects, infertility, progressive lung disease, or recurrent pneumonia for possible primary ciliary dyskinesia or another systemic disorder.[151][278]
- ▸CRS-like disease with renal involvement or destructive upper-airway features may represent granulomatosis with polyangiitis and requires prompt reassessment.[156]
- ▸Repeated systemic glucocorticosteroid courses carry cumulative short- and long-term adverse-effect risks, and no universally accepted safe cumulative threshold has been established.[478]
- ▸Postoperative complications include pain, bleeding, healing problems, and recurrent inflammatory disease; evidence for interventions such as local bupivacaine and heated saline remains procedure- and study-specific.[410][476]
- ▸CRSwNP may recur or remain inadequately controlled after surgery or biologic treatment, requiring ongoing medical therapy, biologic switching, or revision management.[417][457][475]
Disease-related complications
Chronic rhinosinusitis (CRS) is associated with substantial sinonasal morbidity, including persistent nasal obstruction, facial symptoms, rhinorrhoea or post-nasal discharge, olfactory dysfunction, mucosal inflammation, and recurrent disease requiring continued medical or surgical treatment.[417]A1a[475][479][480] Olfactory impairment may be compounded by environmental exposure: a prospective clinical study found associations between heavy-metal concentrations in nasal mucosa or secretions, olfactory function, nasal airflow, and histopathological changes in patients undergoing nasal surgery for CRS, nasal polyposis, or septal deviation.[480] Ambient air pollution has also been associated with increased outpatient burden from CRS in a US metropolitan ecological cohort, although the observational design does not establish causation.[481]
CRS may occur as part of an underlying systemic or inherited disorder. Primary ciliary dyskinesia (PCD) is characterized by progressive lung disease, chronic rhinosinusitis, recurrent otitis media, laterality defects, and reduced fertility; delayed diagnosis may increase morbidity.[151]D5 In children with recurrent pneumonia, an underlying disorder was identified in most patients in a systematic review, supporting evaluation for conditions that may coexist with chronic sinonasal disease when respiratory infections are recurrent or unusually severe.[278]C4 Cystic fibrosis may also produce significant sinonasal disease; elexacaftor–tezacaftor–ivacaftor is used in cystic fibrosis, but evidence regarding extrapulmonary benefit and adverse effects after lung transplantation remains limited.[477]
CRS-like manifestations can signal systemic inflammatory disease rather than uncomplicated CRS. Otolaryngologic manifestations of granulomatosis with polyangiitis (GPA) may precede systemic symptoms and are frequently misdiagnosed as CRS or infection, potentially delaying treatment and increasing the risk of irreversible renal damage.[156]C4 Inflammatory bowel disease can also involve the ear, nose, and throat, and this spectrum is considered underrecognized despite potential morbidity.[165]C4 In transplant recipients, immunosuppressive regimens may influence the development and clinical course of CRS; a multisite retrospective cohort evaluated CRS after kidney or liver transplantation, although the available evidence is observational.[404]B2b
Treatment-related complications
Systemic glucocorticosteroids can cause short- and long-term adverse effects in patients treated for inflammatory upper- and lower-airway disease. A systematic review and meta-analysis specifically examined adverse effects associated with repeated short courses, cumulative exposure, dose–response relationships, rhinitis, rhinosinusitis, and asthma; no universally accepted safe cumulative exposure threshold has been established.[478] Repeated or prolonged systemic corticosteroid use should therefore be limited to appropriate indications and balanced against cumulative toxicity.[478]
Intranasal corticosteroids are generally used to control CRS inflammation, but unpleasant administration effects—including post-nasal drip and nasal irritation—may impair adherence.[453] A crossover trial in postoperative CRS evaluated a novel adaptor intended to improve tolerability of fluticasone delivery; the study addressed acceptability and treatment experience rather than establishing superiority for long-term disease control.[453] Exhalation-delivery fluticasone is designed to reach sinonasal regions above the inferior turbinate that may not be reached by standard sprays; a systematic review and meta-analysis evaluated effects on SNOT-22, congestion, facial pain, olfactory dysfunction, rhinorrhoea, polyp scores, surgical indication, and adverse events.[417]A1a
Endoscopic sinus surgery (ESS) carries perioperative and postoperative risks, including pain, bleeding, healing complications, and recurrent inflammatory disease.[410]A1b[476][479] In a randomized trial of 80 ESS patients, local bupivacaine injection involving the sphenopalatine ganglion and anterior ethmoid nerve was assessed for postoperative pain reduction and systemic analgesic requirements.[410]A1b A small randomized within-person trial evaluated 42°C saline irrigation for intraoperative haemostasis and assessed surgical field quality, operative time, histopathological changes, and postoperative complications; its sample size was 13 patients, limiting certainty about uncommon harms.[476]
The extent of middle-turbinate surgery may influence safety considerations. A meta-analysis of 25 studies involving 4,314 cases found no significant difference between middle-turbinate resection and preservation in SNOT-22, olfactory improvement, or Lund–Kennedy endoscopic score, while postoperative safety and complications were also evaluated.[399]B2a These findings do not establish that either strategy is universally preferable, but they support individualized surgical decision-making.[399]B2a
Recurrence and treatment failure
CRS with nasal polyps (CRSwNP) may persist or recur after ESS, necessitating continued intranasal corticosteroids, irrigation, mucoactive therapy, biologics, or revision treatment.[475][479][417]A1a In a multicenter randomized trial of postoperative CRSwNP, eucalyptol, limonene, and pinene enteric capsules were studied alongside intranasal corticosteroids for clinical outcomes, nasal ciliary function, inflammatory biomarkers, computed tomography, endoscopy, and quality of life over 12 weeks; the evidence concerns a postoperative treatment strategy and does not eliminate the possibility of recurrence.[475] Postoperative irrigation is used to support healing and symptom control; a randomized cohort compared isotonic 0.9% saline with hypertonic 2.3% saline containing algal extracts in CRSwNP after ESS.[479]
Biologic therapy may also fail to provide adequate control. In a retrospective cohort of 400 adults with CRSwNP, 70 patients (18%) switched biologics after a mean of 38 months, illustrating treatment modification in a subset with inadequate or unsatisfactory response.[457] Real-world dupilumab data in 21,249 patients with CRSwNP and/or asthma evaluated lymphoma, cardiovascular events, eosinophilia, joint pain, inflammatory arthritis, and sleep apnoea compared with non-users and other biologics; interpretation is limited by the retrospective database design.[482]
Psychological and quality-of-life complications
Persistent sinonasal symptoms and treatment burden can substantially impair quality of life, as reflected by use of SNOT-22 and other patient-reported outcomes in CRS studies.[399]B2a[417]A1a[475][457] Empty nose syndrome is a distinct postoperative condition characterized by a persistent sensation of nasal obstruction despite a patent airway. A systematic review of 401 patients reported depression in 76.6% and anxiety in 77.0%, emphasizing the need to recognize psychological morbidity when symptoms are disproportionate to objective nasal patency.[107]A1a
Diagnostic warning signs
Features that should prompt reassessment of a presumed CRS diagnosis include recurrent severe lower-airway infections, laterality abnormalities, infertility, recurrent otitis, renal involvement, systemic inflammatory symptoms, unusual crusting or destructive disease, immunosuppression, and poor response to standard therapy.[151]D5[156]C4[165]C4[278]C4[404]B2b These findings may indicate PCD, cystic fibrosis, GPA, inflammatory bowel disease, immunosuppression-related disease, or another underlying condition rather than isolated CRS.[151]D5[156]C4[165]C4[404]B2b[477]
Prognosis and Natural History
- ▸CRS has a variable, often persistent course, while CRSwNP is particularly prone to postoperative recurrence.[464][469]
- ▸Recurrence should be monitored over the long term; prediction studies assessed outcomes through **15 years** after ESS.[502]
- ▸Early recurrence may be defined within **6 months** or **1 year**, depending on the study, and definitions are not standardized.[469][489]
- ▸Asthma, AERD/NSAID hypersensitivity, eosinophilia, polyp burden, edema, and radiologic extent are recurring prognostic variables, but no single marker is universally validated.[483][502][503][511]
- ▸Postoperative corticosteroid therapy was associated with lower recurrence than ESS alone (OR **0.57**) in a meta-analysis of eight studies.[336]
- ▸Biologics, vitamin D, metabolic interventions, and CFTR-modulator therapy may influence outcomes in selected populations, but evidence remains phenotype-specific or limited.[308][330][464][483][485][509]
Overall course
Chronic rhinosinusitis (CRS) is a heterogeneous, persistent inflammatory disorder that can substantially impair quality of life, with outcomes varying according to phenotype, comorbidity, inflammatory profile, treatment adherence, and prior surgery.[464] Chronic rhinosinusitis with nasal polyps (CRSwNP) is particularly prone to persistent disease and postoperative recurrence, although recurrence rates and timing differ across cohorts and definitions.[469][502][503]
In preschool children, the course may not be uniformly persistent. In a 5-year prospective cohort of children aged 4–8 years with CRS symptoms, 117 of 133 participants completed follow-up; the study evaluated early clinical and multi-omics predictors of CRS persistence and later house-dust-mite allergic rhinitis, indicating that early-life allergic and molecular characteristics may help distinguish persistent from resolving disease.[375]B2b The available evidence does not establish that every child with CRS progresses to chronic disease, and pediatric biologic evidence remains sparse and largely indirect.[509]C Among children recovering from acute sinusitis with orbital complications, a retrospective cohort of 181 patients assessed subsequent acute sinusitis, sinus surgery, and CRS, but the available study summary does not provide a definitive incidence estimate or establish causality.[490]C
Recurrence after surgery
Endoscopic sinus surgery (ESS/FESS) improves access for topical therapy but does not eliminate the underlying inflammatory tendency. A retrospective cohort of 543 postoperative CRS patients evaluated recurrence at 2, 5, 10, and 15 years using age, sex, smoking, asthma, NSAID hypersensitivity, symptom duration, blood eosinophil count, nasal polyp score, postoperative edema, and Lund–Mackay score; both discrete-time and Cox models were assessed for long-term prediction.[502] These findings support recurrence as a time-dependent outcome requiring prolonged follow-up rather than a complication limited to the early postoperative period.[502]
In CRSwNP, recurrence can occur early. A multicohort nomogram study defined early recurrence as endoscopically detected polyps within 6 months after ESS and developed a model using 260 patients with internal validation in 114 patients and external validation in 242 patients.[489] Another study defined recurrence as the first postoperative endoscopic detection of polyps within 2 years and developed an internally validated model for the 2-year recurrence-free rate in 404 patients.[503] These tools are prognostic aids rather than universally validated clinical standards, because they were derived from retrospective cohorts and require external validation.[489][503]
Recurrence risk is biologically heterogeneous. In a cohort of 91 patients after FESS, rapid recurrence was defined as recurrence within 1 year, whereas slow or absent recurrence required more than 2 years without recurrence.[469] Tissue proteomics and ELISA identified an innate-myeloid inflammatory axis associated with recurrence, and the study also assessed tissue changes induced by dupilumab; the findings suggest that recurrence may be driven by inflammatory pathways beyond conventional type 2 markers.[469] A prospective cohort of 69 patients followed for up to 3 years evaluated blood periostin, eotaxin-3, procalcitonin, IL-33, and eosinophilia as possible recurrence predictors, but circulating biomarkers remain insufficiently validated for routine prognostication.[511] Spatial and single-cell analyses further implicated subepithelial ALOX15-positive macrophage niches and an ALOX15–ERK–CCL13 pathway in eosinophil recruitment in eosinophilic CRSwNP, a phenotype characterized by intense type 2 inflammation and high recurrence.[460]C
Factors associated with outcome
Asthma, NSAID hypersensitivity/AERD, eosinophilia, greater polyp burden, postoperative edema, and radiologic disease extent have been incorporated into recurrence prediction models, although their independent prognostic value varies by population and model.[483][502][503] AERD is described as a refractory type 2 inflammatory disorder with limited durability from conventional therapy and high recurrence; however, AERD-specific randomized biologic trials remain scarce.[483]
Metabolic status may also influence postoperative disease. A multicenter study evaluated at least 3 years of follow-up among patients with bilateral CRSwNP, comparing normoglycemia, dysglycemia without antidiabetic therapy, and dysglycemia treated with antidiabetic agents to assess recurrence associations.[507] The abstract does not establish a definitive causal effect. Similarly, retrospective comparisons of FESS with more extensive nasalisation included 480 operations over a 10-year period; nasalisation patients had more severe baseline obstruction, olfactory impairment, and polyp burden, so postoperative comparisons are subject to baseline confounding.[504]
Treatment and prognosis
Adjunctive postoperative corticosteroids appear to reduce recurrence. A meta-analysis of eight studies involving 776 patients found lower polyp recurrence with ESS plus corticosteroid therapy than with ESS alone (OR 0.57, 95% CI 0.33–0.97) and better SNOT-22 outcomes, although the evidence was based on heterogeneous clinical studies.[336]B2a Difficult-to-treat postoperative CRSwNP may have delayed cavity epithelialisation when obstructive edema or polypoid tissue limits topical delivery; a retrospective cohort of 102 adults evaluated office debridement followed by supine head-hanging budesonide instillation, but this design cannot prove comparative effectiveness.[510]C Poor tolerability of intranasal sprays may reduce long-term adherence; a crossover trial in postoperative CRS participants tested a metered-dose inhaler adaptor intended to reduce irritation and postnasal drip, with 16 participants in the CRS group.[453]
Biologics may modify the long-term trajectory in severe CRSwNP, but comparative durability remains under study. A 12-month prospective real-world cohort of 96 adults receiving mepolizumab assessed symptoms, SNOT-22, polyp score, asthma control, systemic corticosteroid use, and quality of life.[330]B2b Network meta-analysis compared tezepelumab with other biologics and ESS in severe uncontrolled CRSwNP, including outcomes for polyp burden, congestion, smell, SNOT-22, surgery decisions, systemic corticosteroid use, and time to surgery or corticosteroid treatment.[308]A1a In AERD subgroups, systematic review evidence evaluated upper- and lower-airway outcomes with biologics, but the scarcity of AERD-specific randomized trials limits certainty.[483] Pediatric biologic evidence remains limited and indirect, so prognosis and safety cannot be extrapolated confidently from adults.[509]C
Vitamin D has been investigated as a potential modifier of CRS severity, recurrence, quality of life, inflammatory markers, and postoperative outcomes. A systematic review and meta-analysis found that its clinical significance remains uncertain, so vitamin D status or supplementation should not yet be treated as a definitive prognostic marker.[464] In cystic fibrosis, a pediatric retrospective study evaluated 12-month sinonasal outcomes after elexacaftor/tezacaftor/ivacaftor and explored atopy and TAS2R38 genotype; these findings apply specifically to CF-associated CRS and should not be generalized to ordinary CRS.[485]C Finally, CRS may occur in systemic eosinophilic disease: a case report described remission of adolescent-onset ANCA-positive eosinophilic granulomatosis with polyangiitis during benralizumab treatment, but a single case cannot define CRS prognosis.[491]C
| Clinical issue | Time horizon or definition | Evidence |
|---|---|---|
| Early postoperative polyp recurrence | Within 6 months | Retrospective nomogram cohorts [489] |
| Rapid postoperative recurrence | Within 1 year | Tissue predictor cohort [469] |
| Two-year recurrence-free outcome | Within 2 years | Prognostic nomogram cohort [503] |
| Long-term ESS recurrence | 2, 5, 10, and 15 years | Discrete-time/Cox model cohort [502] |
| Postoperative corticosteroid benefit | Recurrence OR 0.57 | Meta-analysis, 8 studies, 776 patients [336]B2a |
Special Populations
- ▸Pediatric CRS: baseline SN-5 >3.6 predicts persistence; CF most common secondary cause
- ▸CF-CRS: CFTR modulator therapy (ETI) improves sinonasal and pulmonary outcomes
Pediatric CRS (PCRS): common, often underdiagnosed; eosinophilic CRS most frequent primary phenotype (20.2%); CF most common secondary cause (13.8%) [21]C4. Baseline SN-5 score >3.6 predicts persistence at 5 years (OR 3.41) [375]B2b. Diagnosis: nasal endoscopy, CT, evaluate for immune deficiency and allergic rhinitis [66]D5. Sinus balloon catheter dilation (SBCD) in children aged 7-12 years improves SN-5 and VAS at 1 year [315]B3b. Biologics: FDA-approved for other atopic conditions in children; compassionate-use dupilumab trial ongoing [431]B2a. Pregnancy and lactation: no dedicated studies; intranasal corticosteroids considered safe; avoid systemic corticosteroids; defer elective surgery until postpartum. Elderly: HRT in women ≥55 years associated with lower odds of ESS (OR 0.28) [321]B2b; dupilumab in age ≥50 increases arthritis-related adverse events (OR 1.81) [436]C4; OSA common (OR 1.91 for ESS) [238]B3b. Immunocompromised (CF): CFTR modulator therapy (elexacaftor-tezacaftor-ivacaftor) improves sinonasal outcomes (Lund-Mackay from 5.8 to 3.3 at 1 year) [210]B2b; no RCTs for medical interventions in CF-CRS [434]A1a; surgery may help [331]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
- ▸Screen and counsel for tobacco and relevant occupational inhalational exposures. [441,450]
- ▸Consider targeted immune evaluation in recurrent or unusually severe sinonasal infections, including assessment of functional vaccine responses when clinically indicated. [442,495]
- ▸Recognize CCAD and REAH as phenotypes or mimics requiring focused allergy assessment, imaging, or pathology when appropriate. [125,76]
- ▸Screen for OSA and psychological comorbidity, especially before ESS. [438,498]
- ▸Monitor prolonged budesonide therapy for cumulative corticosteroid exposure and possible adrenal or ocular effects. [439,443]
- ▸Use symptom, endoscopic, imaging, and quality-of-life surveillance after ESS; investigate red flags urgently. [492,493,445]
Prevention and risk reduction
Prevention of chronic rhinosinusitis (CRS) should address modifiable environmental exposures, upper-airway inflammation, immune dysfunction, and perioperative risks. Tobacco-smoke exposure is a preventable risk associated with CRS; clinicians should ask about active and secondhand smoke exposure and provide avoidance counselling. In a case-control study, physician screening and education regarding secondhand smoke were evaluated specifically because exposure may contribute to CRS risk. [441]B3b Occupational inhalational exposure may also be important: World Trade Center–exposed firefighters had increased self-reported CRS diagnoses and symptoms compared with non-exposed firefighters, supporting exposure history and workplace-risk assessment in appropriate populations. [450]B2b Population data from Korea identified CRS prevalence of 6.95% and evaluated sociodemographic and medical risk factors, although these findings do not establish that modification of any single factor prevents CRS. [496]
Respiratory viral infection may contribute to symptom exacerbations or persistent mucosal inflammation. Respiratory viruses were detected by multiplex PCR in nasal lavage or turbinate samples from a substantial proportion of CRS patients, with detection reported in 50.5% of lavage samples and 64.0% of mucosal specimens in one prospective case-control study. [494] These findings support routine infection-prevention measures and assessment for viral triggers during flares, but do not establish antiviral treatment or routine viral testing as CRS prevention strategies. [494]
COVID-19 infection has been associated with increased risk of subsequent new-onset type 2 inflammatory disease in a large retrospective matched electronic-health-record cohort, whereas COVID-19 vaccination was associated with a protective relationship. [449]B2b Rare reports of eosinophilic granulomatosis with polyangiitis temporally following mRNA vaccination have been described, including multisystem disease within 14 days of immunization; these reports cannot establish causality and do not outweigh population-level vaccination benefits. [447]C4[449]B2b
Patients with recurrent acute rhinosinusitis or CRS and suspected humoral immune dysfunction may undergo targeted immune evaluation. Patients with CRS or recurrent acute rhinosinusitis and low pneumococcal antibody titres were studied after 23-valent pneumococcal polysaccharide vaccination; a retrospective cohort assessed subsequent sinusitis encounters and antibiotic or steroid prescriptions. [442]B2b Patients with chronic or recurrent sinusitis also demonstrated weaker average antibody responses to tetanus and diphtheria vaccination than controls, indicating that functional antibody responses may be abnormal despite apparently adequate serum immunoglobulin levels. [495] Vaccination should therefore follow standard indications, while abnormal or recurrent infection patterns should prompt individualized immunologic assessment rather than indiscriminate testing. [442]B2b[495]
Diagnostic screening and comorbidity assessment
Screening should begin with symptom history, nasal endoscopy when indicated, and objective assessment appropriate to the clinical context. Central compartment atopic disease (CCAD) is a CRS phenotype characterized by polypoid oedema and mucosal changes involving the central compartment, particularly the middle and superior turbinates and posterosuperior septum, in association with inhalant allergy. [125]B2a Recognition of this pattern should prompt assessment of allergic disease and consideration of phenotype-directed management. [125]B2a
Respiratory epithelial adenomatoid hamartoma (REAH) can occur with CRS and may mimic inflammatory or neoplastic disease. In a 15-year institutional series, pathology-confirmed REAH involved the olfactory cleft in 55.7% of patients and extra-olfactory regions in 44.3%; extra-olfactory disease occurred in younger patients on average than olfactory-cleft disease. [76]C4 Unilateral, atypical, mass-like, or treatment-resistant disease should therefore be evaluated with appropriate imaging and tissue diagnosis rather than assumed to represent routine CRS. [76]C4
Comorbid obstructive sleep apnoea (OSA) should be considered, particularly before endoscopic sinus surgery (ESS), because approximately 20% of CRS patients may have OSA and undiagnosed OSA increases perioperative risk. [438]B3b The sleep subdomain of the SNOT-22 was evaluated as a possible OSA screening instrument, but it should complement, not replace, validated sleep-apnoea assessment and clinical evaluation. [438]B3b Depression, anxiety, insomnia, and somatic symptom burden are also common concerns among patients awaiting CRS surgery; a prospective study evaluated PHQ-9, GAD-7, Insomnia Severity Index, PHQ-15, and SNOT-22 scores for this purpose. [498]
Medical and postoperative surveillance
Long-term topical corticosteroid therapy requires individualized safety surveillance. In a cohort undergoing stimulated cortisol testing after daily budesonide irrigation for at least 6 months, mean treatment duration was 34 months and hypocortisolism was identified in a subset of patients. [439]B2b Earlier long-term evaluation of budesonide delivered by mucosal atomization assessed hypothalamic–pituitary–adrenal-axis effects and intraocular pressure, supporting attention to systemic steroid exposure, concurrent corticosteroids, adrenal symptoms, and ocular risk in prolonged or high-dose treatment. [443]B2c
After ESS, surveillance should combine symptoms, endoscopic findings, and imaging when clinically indicated. Prospective evaluation of image-guided Draf 2a frontal sinusotomy assessed frontal ostium patency, computed tomography, endoscopy, and disease-specific quality of life at a mean follow-up of 10 months. [493] Biofilm-producing bacteria were studied prospectively for 12 months in patients with CRS with nasal polyposis after ESS, alongside Lund–Mackay, Lund–Kennedy, and SNOT-22 outcomes; the study supports monitoring objective disease and health-related quality of life, but does not establish routine biofilm testing or eradication therapy. [492]C
Red flags and surgical safety
Severe frontal headache, forehead swelling, fever, orbital findings, neurological symptoms, or rapidly progressive disease require urgent assessment for complications such as Pott’s puffy tumour, which comprises frontal-bone osteomyelitis with a subperiosteal abscess and has been systematically reviewed in children and adolescents. [445]C4 During FESS, controlled hypotension may reduce bleeding and improve visualization, but excessive blood-pressure reduction can cause haemodynamic instability and potentially neurological or renal ischaemic complications; blood-pressure targets should therefore be individualized with continuous anaesthetic monitoring rather than applied uniformly. [277]D5
CRS and allergic rhinitis have been investigated as possible associations with nasopharyngeal carcinoma and paranasal sinus malignancy in older adults, and imaging-based studies have examined associations between CRS and ischaemic stroke. [444]B3b[497] These observational associations do not justify population cancer or stroke screening solely because of CRS; new focal neurological deficits, unilateral persistent disease, epistaxis, visual symptoms, or an atypical mass warrant prompt specialist evaluation. [444]B3b[497]
| Domain | When to consider | Evidence-informed action |
|---|---|---|
| Exposure | Smoke exposure or relevant occupational inhalants | Ask, document, counsel on avoidance, and address workplace risks. [441]B3b[450]B2b |
| Immunity | Recurrent acute rhinosinusitis, CRS with frequent infections, or low pneumococcal titres | Consider targeted antibody and functional vaccine-response assessment. [442]B2b[495] |
| Comorbidity | Sleep symptoms, perioperative assessment, mood or insomnia concerns | Use validated OSA and mental-health instruments as appropriate. [438]B3b[498] |
| Treatment safety | Daily or prolonged topical budesonide, especially with other corticosteroids | Review cumulative exposure and consider adrenal or ocular surveillance. [439]B2b[443]B2c |
| Red flags | Forehead swelling, orbital or neurological signs, unilateral mass, or atypical progression | Arrange urgent imaging, specialist review, and tissue diagnosis when indicated. [445]C4[76]C4 |
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 - [451]
Han JK, Mullol J, Wagenmann M et al.. “Mepolizumab improves outcomes in patients with CRSwNP with one or more prior nasal polyp surgeries.” Rhinology (2026). PMID: 42206465 ↗
L1bCited in: History and Evolution of Treatment - [452]
Bożek A, Urbaniec E, Miodońska M et al.. “Efficacy of omalizumab in moderate chronic rhinosinusitis with nasal polyps and IgE-mediated asthma.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2026). PMID: 41765284 ↗
L1bCited in: History and Evolution of Treatment - [453]
Ranasinghe S, Berger X, Kimita W et al.. “A Novel Device to Improve the Tolerability of Intranasal Corticosteroid Sprays for Allergic Rhinitis and Postoperative Chronic Rhinosinusitis: A Crossover Trial.” Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (2026). PMID: 42363677 ↗
L1bCited in: History and Evolution of Treatment - [454]
Zhou AS, Zhao M, Ghannam JY et al.. “Does Psychological Dysfunction Impact 5-Year Quality of Life Outcomes After Endoscopic Sinus Surgery?” The Laryngoscope (2026). PMID: 42420204 ↗
L2bCited in: History and Evolution of Treatment - [455]
Haase C, Håkansson KEJ, Schwarz P et al.. “Corticosteroid Exposure in Chronic Rhinosinusitis and Global Airway Disease: Adrenal and Bone Impact.” The Laryngoscope (2026). PMID: 41916727 ↗
L2bCited in: History and Evolution of Treatment - [456]
Zurlo M, Ambrosani F, Maule M et al.. “Trends of T2 and Non-T2 Cytokines During Mepolizumab Treatment in Different Asthma Patient Subgroups.” Biomedicines (2026). PMID: 41898189 ↗
L2bCited in: History and Evolution of Treatment - [457]
Fu BJ, Jimenez I, Chang MT et al.. “Outcomes of Biologic Switching in Chronic Rhinosinusitis With Nasal Polyps.” American journal of rhinology & allergy (2026). PMID: 42599678 ↗
L3bCited in: History and Evolution of Treatment - [458]
Kinealy BP, Mangino AA, Johnson JD et al.. “Revision Endoscopic Sinus Surgery in Cystic Fibrosis With Chronic Rhinosinusitis: Before and After Cystic Fibrosis Transmembrane Conductance Regulator Triple Modulator Therapy.” American journal of rhinology & allergy (2026). PMID: 42545167 ↗
L3bCited in: History and Evolution of Treatment - [459]
Máspero JF, Arnaout RK, Vargas-Ramírez L et al.. “Baseline Characteristics of Patients with Asthma Initiating Dupilumab in a Real-World Setting: The REVEAL Registry.” Advances in therapy (2026). PMID: 42268495 ↗
L3bCited in: History and Evolution of Treatment - [460]
Cui Y, Liu C, Wang K et al.. “Subepithelial ALOX15+ macrophage niches orchestrate eosinophil recruitment in chronic rhinosinusitis with nasal polyps via the ALOX15-ERK-CCL13 axis.” Rhinology (2026). PMID: 42467066 ↗
L4Cited in: History and Evolution of Treatment - [461]
Türk B, Tarakçı F, Memioğlu M et al.. “Toward a multidisciplinary perspective: Are dental-origin pathologies overlooked in unilateral chronic rhinosinusitis?” Auris, nasus, larynx (2026). PMID: 42407144 ↗
L4Cited in: History and Evolution of Treatment - [462]
Grose E, Xiao JB, Macinnis P et al.. “Olfactory Outcomes After Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyposis.” Laryngoscope investigative otolaryngology (2026). PMID: 42292752 ↗
L4Cited in: History and Evolution of Treatment - [463]
Fedosenko SV, Junek M, Garrido CV et al.. “Clinical and Laboratory Transition Between GPA and EGPA.” Chest (2026). PMID: 42575656 ↗
L4Cited in: History and Evolution of Treatment - [464]
Sumaily I, Otaif AA, Kariri KI et al.. “Assessing the role of vitamin D in the prevention and management of chronic rhinosinusitis: a systematic review and meta-analysis.” Frontiers in immunology (2026). PMID: 42568492 ↗
L1aCited in: Surgical Technique, Approaches and Perioperative Care - [465]
Järvekülg M, Virkkula P, Wikstén J et al.. “Crushing Versus Resection of Concha Bullosa as an Adjunct to FESS: Long-Term Randomized Controlled Trial.” The Laryngoscope (2026). PMID: 42533380 ↗
L1bCited in: Surgical Technique, Approaches and Perioperative Care - [466]
Virkkula P, Hammarén-Malmi S, Laulajainen-Hongisto A et al.. “Efficacy of Full and Limited Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Nasal Polyps: A Randomised Controlled Trial.” Allergy (2026). PMID: 42530386 ↗
L1bCited in: Surgical Technique, Approaches and Perioperative Care - [467]
Luong AU, Alsaleh S, Hwang SH et al.. “Allergic Fungal Rhinosinusitis: Distinct Clinical Features, Diagnostic Challenges, and Evolving Therapeutic Strategies.” The journal of allergy and clinical immunology. In practice (2026). PMID: 42392262 ↗
L1bCited in: Surgical Technique, Approaches and Perioperative Care - [468]
Swenson A, Ahmed W, Silver J et al.. “Mepolizumab reduces healthcare resource utilization in patients with chronic rhinosinusitis with nasal polyps: a linked EMR and claims-based pre-post study.” Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology (2026). PMID: 42323698 ↗
L1bCited in: Surgical Technique, Approaches and Perioperative Care - [469]
Dharia T, Zawacki M, Maurer R et al.. “Beyond Type 2 Inflammation: An Innate-Myeloid Axis is Linked to CRSwNP Recurrence.” The Journal of allergy and clinical immunology (2026). PMID: 42567484 ↗
L2bCited in: Surgical Technique, Approaches and Perioperative Care - [470]
Chaushu H, Bilaus R, Neiderman NC et al.. “Histopathological Evidence of Persistent Remodeling in Recurrent Acute Rhinosinusitis.” American journal of rhinology & allergy (2026). PMID: 42530540 ↗
L4Cited in: Surgical Technique, Approaches and Perioperative Care - [471]
Witkowska-Janik A, Wojdas A, Sobol M et al.. “Th2 and Th17/Th1 Inflammatory Profiles in Chronic Rhinosinusitis: Associations with Vitamin D Status and Disease Severity.” International journal of molecular sciences (2026). PMID: 42450326 ↗
L4Cited in: Surgical Technique, Approaches and Perioperative Care - [472]
Luong AU, Levy JM, Wise SK et al.. “Dupilumab for patients with allergic fungal rhinosinusitis.” The Journal of allergy and clinical immunology (2026). PMID: 42498125 ↗
L2bCited in: Surgical Technique, Approaches and Perioperative Care - [473]
Berbalk K, Campion NJ, Bartosik TJ et al.. “Does Prior Sinus Surgery Influence Dupilumab Treatment Response in CRSwNP?” Clinical and experimental otorhinolaryngology (2026). PMID: 42596754 ↗
L3bCited in: Surgical Technique, Approaches and Perioperative Care - [474]
Ni HS, Zhang LY, Lu HQ et al.. “Socioeconomic and regional influences on eosinophilic inflammation in chronic rhinosinusitis with nasal polyps.” The World Allergy Organization journal (2026). PMID: 42571263 ↗
L3bCited in: Surgical Technique, Approaches and Perioperative Care - [475]
Sima Y, Liu J, Liu J et al.. “A Multicenter, Randomized, Controlled Clinical Trial on the Efficacy and Safety of Eucalyptol, Limonene, and Pinene Enteric Capsules in the Treatment of Chronic Rhinosinusitis With Nasal Polyps Postoperatively.” Clinical and translational allergy (2025). PMID: 41327929 ↗
L1bCited in: Complications - [476]
Shimizu A, Makihara S, Uraguchi K et al.. “A randomized, double-blind, within-person trial of hot saline at 42 °C for endoscopic sinus surgery.” Acta oto-laryngologica (2025). PMID: 41134913 ↗
L1bCited in: Complications - [477]
Venditto L, Neece A, Forgione F et al.. “Safety and extrapulmonary effects of elexacaftor-tezacaftor-ivacaftor in people with cystic fibrosis following lung transplantation: A systematic review and meta-analysis.” Paediatric respiratory reviews (2026). PMID: 42120233 ↗
L2aCited in: Complications - [478]
Scheire S, Lourijsen E, Blauwblomme M et al.. “Meta-Analysis on the Harm of Systemic Glucocorticosteroids in Inflammatory Upper Airway Disease and Asthma: An EAACI Task Force.” Allergy (2026). PMID: 42011838 ↗
L2aCited in: Complications - [479]
Penezić A, Kalogjera L, Grgić MV et al.. “EFFICACY OF NASAL IRRIGATION WITH ISOTONIC AND HYPERTONIC SOLUTIONS AFTER ENDOSCOPIC SINUS SURGERY FOR CHRONIC RHINOSINUSITIS WITH NASAL POLYPOSIS.” Acta clinica Croatica (2025). PMID: 41340805 ↗
L1bCited in: Complications - [480]
Malvić G, Janković S, Klepac D et al.. “Nasal Mucosal Heavy Metal Accumulation, Olfactory Dysfunction, and Histopathological Changes: A Prospective Clinical Study.” Journal of clinical medicine (2026). PMID: 42513371 ↗
L3bCited in: Complications - [481]
Yang HH, Velasquez E, Hwang PH. “Metropolitan air pollution and the upper and lower airway: chronic rhinosinusitis and asthma outpatient burden.” Rhinology (2026). PMID: 42333495 ↗
L3bCited in: Complications - [482]
Anisman EJ, Short S, Tam E et al.. “Dupilumab Beyond the Airway: Decreased Morbidity in a Real-World Analysis.” International forum of allergy & rhinology (2026). PMID: 41649402 ↗
L3bCited in: Complications - [483]
Du Z, Liu W, Zheng Y et al.. “Biologics and Selected Upper- and Lower-Airway Outcomes in AERD Subgroups: A Systematic Review and Meta-Analysis.” The journal of allergy and clinical immunology. In practice (2026). PMID: 42526834 ↗
L1aCited in: Prognosis and Natural History - [484]
Kim DH, Jang DW, Hwang SH. “Efficacy of tezepelumab in chronic rhinosinusitis with nasal polyps: 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: 42165888 ↗
L1aCited in: Prognosis and Natural History - [485]
Terracciano R, Cerchione R, Cimbalo C et al.. “The role of ETI therapy in managing sinusitis in cystic fibrosis pediatric population: A study on clinical outcomes.” Respiratory medicine (2026). PMID: 42521036 ↗
L4Cited in: Prognosis and Natural History - [486]
Kirtsreesakul V, Thongsuksai P, Sanghan N et al.. “CBC-Derived Biomarkers Associated With Recurrence After Sinus Surgery in Chronic Rhinosinusitis.” The Laryngoscope (2026). PMID: 42212465 ↗
L3bCited in: Prognosis and Natural History - [487]
Lucidi D, Seccia V, Mastrapasqua R et al.. “Switching to dupilumab from other biologic therapies in chronic rhinosinusitis with nasal polyps (CRSWNP): a comparison with biologic-naïve patients.” 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: 42087001 ↗
L3bCited in: Prognosis and Natural History - [488]
Miechowski W, Czerwaty K, Dzaman K. “Steroid-eluting stents in chronic rhinosinusitis: a systematic review.” Otolaryngologia polska = The Polish otolaryngology (2026). PMID: 42138052 ↗
L2aCited in: Prognosis and Natural History - [489]
Zhang H, Zheng H, Wang S et al.. “Development and validation of a nomogram based on LASSO regression for predicting early postoperative polyp recurrence in patients with chronic rhinosinusitis with nasal polyps.” Frontiers in surgery (2026). PMID: 42523713 ↗
L3bCited in: Prognosis and Natural History - [490]
Phung C, Wei K, Rizzi MD et al.. “Long-term outcomes after recovery from pediatric acute sinusitis with orbital complications.” International journal of pediatric otorhinolaryngology (2026). PMID: 42235165 ↗
L4Cited in: Prognosis and Natural History - [491]
Terzic M, Plavsic A, Djordjevic S et al.. “Case Report: Benralizumab-induced remission in adolescent-onset ANCA-positive eosinophilic granulomatosis with polyangiitis.” Frontiers in immunology (2026). PMID: 42528702 ↗
L4Cited in: Prognosis and Natural History - [492]
Milovanović J, Božić DD, Pavlović B et al.. “Biofilm-producing Bacteria and Quality of Life after Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyposis.” American journal of rhinology & allergy (2024). PMID: 38454786 ↗
L4Cited in: Prevention, Screening and Surveillance - [493]
Askar MH, Gamea A, Tomoum MO et al.. “Endoscopic Management of Chronic Frontal Sinusitis: Prospective Quality of Life Analysis.” The Annals of otology, rhinology, and laryngology (2015). PMID: 25736024 ↗
L2bCited in: Prevention, Screening and Surveillance - [494]
Cho GS, Moon BJ, Lee BJ et al.. “High rates of detection of respiratory viruses in the nasal washes and mucosae of patients with chronic rhinosinusitis.” Journal of clinical microbiology (2013). PMID: 23325817 ↗
L3bCited in: Prevention, Screening and Surveillance - [495]
Tahkokallio O, Koskinen A, Kentala E et al.. “Antibody responses to tetanus and diphtheria vaccine in chronic and recurrent rhinosinusitis.” Rhinology (2011). PMID: 21468381 ↗
L3bCited in: Prevention, Screening and Surveillance - [496]
Kim YS, Kim NH, Seong SY et al.. “Prevalence and risk factors of chronic rhinosinusitis in Korea.” American journal of rhinology & allergy (2011). PMID: 21679523 ↗
L3bCited in: Prevention, Screening and Surveillance - [497]
Cho EH, Park KH, Kim JH et al.. “Side- and Sinus-Specific Relationships between Chronic Rhinosinusitis and Ischemic Stroke Using Imaging Analyses.” Diagnostics (Basel, Switzerland) (2024). PMID: 38928681 ↗
L3bCited in: Prevention, Screening and Surveillance - [498]
Peng L, Wang HF, Wang DF et al.. “Screening for Psychiatric Disorders in Chronic Rhinosinusitis Patients Waiting for Surgery: A Prospective Cross-Sectional Study.” Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (2024). PMID: 39358666 ↗
L3bCited in: Prevention, Screening and Surveillance - [499]
Chakravorty A, Lin ME, Lubner R et al.. “Efficacy and Predictors of Response to Biologic Therapy and Endoscopic Sinus Surgery in Patients With Nasal Polyps: A Systematic Review.” International forum of allergy & rhinology (2026). PMID: 42716513 ↗
L1aCited in: Surgical Technique, Approaches and Perioperative Care - [500]
Huang Z, Xu Z, Yiming W et al.. “Clinical efficacy of an extended local treatment in nasal polyps with different endotypes: A prospective randomized controlled study.” The World Allergy Organization journal (2026). PMID: 42733474 ↗
L1bCited in: Surgical Technique, Approaches and Perioperative Care - [501]
Brociek-Piłczyńska A, Stępińska M, Kwiatkowska M et al.. “Bacterial Profile Stability of Middle Meatus Following Endoscopic Sinus Surgery: A Prospective Pilot Study.” American journal of rhinology & allergy (2026). PMID: 42669802 ↗
L4Cited in: Surgical Technique, Approaches and Perioperative Care - [502]
Kirtsreesakul V, Thongsuksai P, Sanghan N et al.. “Enhancing Long-Term Recurrence Prediction in Chronic Rhinosinusitis Following Endoscopic Sinus Surgery Using a Discrete-Time Model.” Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2026). PMID: 42732470 ↗
L3bCited in: Surgical Technique, Approaches and Perioperative Care - [503]
Yang Y, Geng C, Luo J et al.. “Development and internal validation of a prognostic nomogram for recurrence in chronic rhinosinusitis with nasal polyps after functional endoscopic sinus surgery.” Frontiers in medicine (2026). PMID: 42724079 ↗
L3bCited in: Surgical Technique, Approaches and Perioperative Care - [504]
Manestar D, Ledić EA, Janković S et al.. “Comparative outcomes of nasalisation vs functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyposis: a 10-year retrospective study.” Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale (2026). PMID: 42708439 ↗
L3bCited in: Surgical Technique, Approaches and Perioperative Care - [505]
Zhao YP, Fu XS, Jia Y et al.. “Low-dose esketamine for postoperative pain, sleep, and hemodynamic stability in functional endoscopic sinus surgery: a retrospective cohort study.” Frontiers in pain research (Lausanne, Switzerland) (2026). PMID: 42643476 ↗
L3bCited in: Surgical Technique, Approaches and Perioperative Care - [506]
Smith SS, Kaefer SL, Duvvuru H et al.. “Biologics Adoption in CRSwNP and the Associated Decline in Endoscopic Sinus Surgery: A Longitudinal Claims Database Study.” International forum of allergy & rhinology (2026). PMID: 42643130 ↗
L3bCited in: Surgical Technique, Approaches and Perioperative Care - [507]
Im YH, Park CS, Kim DH et al.. “Effects of Glycemic Status and Antidiabetic Agents on the Recurrence of Chronic Rhinosinusitis with Nasal Polyps: A Multicenter Study.” American journal of rhinology & allergy (2026). PMID: 42606336 ↗
L3bCited in: Surgical Technique, Approaches and Perioperative Care - [508]
Ghannam JY, Zhou AS, Gray ST et al.. “Effect of Body Mass Index on Long-Term Outcomes After Endoscopic Sinus Surgery.” The Laryngoscope (2026). PMID: 42547224 ↗
L3bCited in: Surgical Technique, Approaches and Perioperative Care - [509]
Loperfido A, Anzivino R, Galletti C et al.. “Biologics in pediatric chronic rhinosinusitis with nasal polyps: A systematic review of efficacy and safety.” Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2026). PMID: 42747120 ↗
L4Cited in: Prognosis and Natural History - [510]
Wang L, Zhou M, Yuan S et al.. “Combined in-office endoscopic debridement and supine head-hanging budesonide instillation for postoperative difficult-to-treat chronic rhinosinusitis with nasal polyps: a retrospective cohort study.” Frontiers in allergy (2026). PMID: 42712404 ↗
L4Cited in: Prognosis and Natural History - [511]
Florean MD, Mare C, Gâta A et al.. “Serum Biomarkers as Predictors of Recurrence in Chronic Rhinosinusitis with Nasal Polyps.” Medicina (Kaunas, Lithuania) (2026). PMID: 42654349 ↗
L2bCited in: Prognosis and Natural History