Abstract
Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory condition of the paranasal sinuses and nasal passage. It is characterized as inflammation of the sinonasal passage, presenting with two or more symptoms (nasal blockage, secretions, facial pain and headaches) for more than 12 weeks consecutively. The disease is phenotypically differentiated based on the presence of nasal polyps; CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Traditionally, CRSwNP has been associated with a type 2 inflammatory profile, while CRSsNP has been associated with a type 1 inflammatory profile. Extensive work in characterizing the inflammatory profiles of CRS patients has challenged this dichotomy, with great variation both between and within populations described. Recent efforts of endotyping CRS based on underlying pathophysiology have further highlighted the heterogeneity of the disease, revealing mixed inflammatory profiles coordinated by a number of inflammatory cell types. This review will highlight the current understanding of inflammation in CRS, and discuss the importance and impact of refining this understanding in the development of appropriate treatment options for CRS sufferers.
Highlights
Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory condition of the paranasal sinuses and nasal passage
Endoscopic or CT interpretation of the state of sinus disease is used as a diagnostic tool and allows the disease to be phenotypically differentiated into two classes; CRS with nasal polyps (CRSwNP)
A type 3 response is mediated by T helper 17 (Th17) cells, which mature in response to Transforming Growth Factor β (TGFβ) and IL-6
Summary
Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory condition of the paranasal sinuses and nasal passage. It is considered one of the most prevalent chronic diseases worldwide, conservatively affecting around 8.5% of the Australian population and placing significant direct and indirect healthcare costs on economies globally [1,2]. Where pharmacological intervention is insufficient, endoscopic sinus surgery is performed, with the aim of widening the openings of the sinuses, removing inflammatory tissue, reducing inflammatory load, and in CRSwNP, removing nasal polyps [5]. Despite these guidelines, around 30% of CRS patients experience difficulties managing symptoms [3].
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