Endotype-driven care pathways in chronic rhinosinusitis (CRS)

Chronic rhinosinusitis (CRS) has been clinically differentiated in CRS without polyps (CRSsNP) and with polyps (CRSwNP), with both forms subjected to glucocortico-steroids and antibiotics, and - if unsuccessful - to nasal and sinus surgery tailored to the endoscopic and CT scan findings. The elaboration of endotypes based on pathomechanisms involving underlying immune responses offers new possibilities to predict prognosis and risks, and sophisticated guidance in personalized pharmacotherapy, surgical approaches and finally innovative treatment approaches for CRS with biologics. Surgical approaches may vary from classical functional endoscopic sinus surgery (FESS) to extended or "reboot" approaches with the idea to completely remove the dysfunctional and inflamed mucosa and allow it to be replaced by a newly grown healthy mucosa. In the near future, biologics in this field are targeting the type 2 cytokines IL-4, IL-5 and IL-13 as well as IgE; first study results are promising and phase 3 studies currently performed. The development of endotype-driven integrated care pathways appreciating these innovations are urgently needed for the management of CRS.