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Purpose of Review <p>Advances in immunology and molecular biology have shifted the management of chronic rhinosinusitis (CRS) from phenotype-based classification to endotype-driven approaches. This review aims to provide a comprehensive overview of CRS endotypes, their clinical implications, and their role in guiding personalized medical and surgical management.</p> Recent Findings <p>Clinical features that contribute to the refinement of endotype identification for treatment selection include the presence of nasal polyps, comorbid asthma, radiological manifestations, and blood and tissue biomarkers. Biologic therapies, particularly for type 2 CRS, have demonstrated efficacy in reducing inflammation, improving quality of life, and minimizing recurrence. In contrast, non-type 2 CRS responds better to low-dose long-term macrolide therapy, which helps modulate neutrophilic inflammation and optimize surgical outcomes. Endotyping also impacts surgical strategies, as type 2 chronic rhinosinusitis has higher recurrence rates after sinus surgery and often requiring more extensive procedures.</p> Summary <p>Endotype-driven approaches have enhanced treatment precision in CRS, but challenges remain, including limited access to immunological testing and cost-effectiveness concerns. Future research should focus on refining biomarker-driven treatment algorithms and integrating AI-based analytics to optimize personalized therapy, reduce recurrence rates, and improve long-term outcomes.</p>

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Endotypes of Chronic Rhinosinusitis: A Clinical Perspective

  • 期刊论文

  • 发表日期：

    2025年5月16日

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  • Chin-Nung Liu,
  • Yi-Tsen Lin,
  • Steven Chun-Kang Liao,
  • Kao-Tsung Lin,
  • Chih-Feng Lin,
  • Te-Huei Yeh

摘要

Purpose of Review

Advances in immunology and molecular biology have shifted the management of chronic rhinosinusitis (CRS) from phenotype-based classification to endotype-driven approaches. This review aims to provide a comprehensive overview of CRS endotypes, their clinical implications, and their role in guiding personalized medical and surgical management.

Recent Findings

Clinical features that contribute to the refinement of endotype identification for treatment selection include the presence of nasal polyps, comorbid asthma, radiological manifestations, and blood and tissue biomarkers. Biologic therapies, particularly for type 2 CRS, have demonstrated efficacy in reducing inflammation, improving quality of life, and minimizing recurrence. In contrast, non-type 2 CRS responds better to low-dose long-term macrolide therapy, which helps modulate neutrophilic inflammation and optimize surgical outcomes. Endotyping also impacts surgical strategies, as type 2 chronic rhinosinusitis has higher recurrence rates after sinus surgery and often requiring more extensive procedures.

Summary

Endotype-driven approaches have enhanced treatment precision in CRS, but challenges remain, including limited access to immunological testing and cost-effectiveness concerns. Future research should focus on refining biomarker-driven treatment algorithms and integrating AI-based analytics to optimize personalized therapy, reduce recurrence rates, and improve long-term outcomes.