Chronic Rhinosinusitis with Nasal Polyps: Latest Trends in Diagnosis and Treatment

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: 20 May 2026 | Viewed by 1737

Special Issue Editors


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Guest Editor
Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98122 Messina, ME, Italy
Interests: ENT; rhinology; CRSwNP; biologics; head & neck; otology
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Guest Editor Assistant
Faculty of Medicine and Surgery, Kore University of Enna, Enna, Italy
Interests: ENT; rhinology; CRSwNP; biologics; head & neck; otology

Special Issue Information

Dear Colleagues,

With a focus on CRSwNP, this Special Issue proposal discusses crucial aspects of diagnosis, multidisciplinary care, and therapy developments. The goal of this issue is to give a thorough review of the most cutting-edge methods and best practices currently used in clinical practice.

CRSwNP, like other chronic diseases, has a negative impact on the quality of life, and for years there have been serious management problems due to the difficulty of control using only the therapeutic options available until recently. In some cases, despite the high use of systemic corticosteroids and surgical interventions, the patient does not in fact achieve adequate control of their symptoms or a sufficient quality of life. In recent years, however, new therapeutic options have opened up for these patients, thanks to new biological drugs capable of suppressing naso-sinus inflammation, selectively blocking key cytokines of the typical inflammatory mechanisms associated with CRSwNP. We also aim to explore how important it is for multidisciplinary teams to work together to optimize treatment plans and enhance patient care. Case studies and expert perspectives will be used to analyze this collaborative approach, presenting effective examples of interdisciplinary teamwork with allergologists, radiologists, immunologists, and pneumologists.

To correctly classify patients with CRSwNP, a pathology in most cases is supported by eosinophilic inflammation, a solid phenotyping ability, and an integrated multidisciplinary approach, which can allow for both timely diagnosis and selection of the most correct treatment path for all patients. Thus, in conjunction with the advent of new biological therapies indicated for CRSwNP, to promote their most appropriate and integrated application with the "standard of care", it is necessary to build a theoretical–practical training path to develop knowledge and skills around the new evidence and management of this pathology.

Dr. Bruno Galletti
Guest Editor

Dr. Cosimo Galletti
Guest Editor Assistant

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Keywords

  • chronic rhinosinusitis with nasal polyps
  • real-word evidence
  • otorhinolaryngology
  • rhinology, quality of life, therapeutic advances
  • monoclonal antibodies

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Published Papers (2 papers)

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Research

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9 pages, 492 KB  
Article
Efficacy of Dupilumab in Patients with Chronic Rhinosinusitis with Nasal Polyps and Eosinophilic Otitis Media: A Six-Month Observational Study
by Cosimo Galletti, Federica Giammona Indaco, Daniele Portelli, Giulia Laterra, Patrizia Zambito, Maria Grazia Ferrisi, Leonard Freni, Francesco Ciodaro, Francesco Freni, Salvatore Maira and Bruno Galletti
Medicina 2025, 61(8), 1471; https://doi.org/10.3390/medicina61081471 - 15 Aug 2025
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Abstract
Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) and eosinophilic otitis media (EOM) are frequently co-existing eosinophilic disorders related to type 2 inflammation, which significantly impair the quality of life of patients. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha and [...] Read more.
Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) and eosinophilic otitis media (EOM) are frequently co-existing eosinophilic disorders related to type 2 inflammation, which significantly impair the quality of life of patients. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha and anti-IL-13, has demonstrated a promising profile of efficacy and safety in the treatment of CRSwNP; however, evidence on its role in concomitant EOM and CRSwNP remains limited in the literature. This study aims to evaluate the clinical efficacy of dupilumab in patients with concomitant CRSwNP and EOM over a six-month observational period. Materials and Methods: A retrospective observational cohort study was conducted on twenty-two patients (aged 18–75 years) over six months with severe uncontrolled CRSwNP and confirmed refractory EOM who were treated with dupilumab (300 mg every two weeks). Demographic data are collected, and outcome measures included Nasal Polyp Score (NPS), Sino-Nasal Outcome Test (SNOT-22), Visual Analog Scale for nasal congestion (VAS), tympanogram classification, and Chronic Otitis Media Outcome Test (COMOT-15), evaluated at baseline and 6 months. Results: Over the six-month treatment period, patients with coexisting CRSwNP and eosinophilic otitis media experienced significant improvements across the multiple validated clinical and patient-reported outcome measures. The Nasal Polyp Score (NPS) significantly decreased from a median of 5.7 (IQR: 1.2) at baseline to 1.5 (IQR: 1.3) at six months (p < 0.0001). The SNOT-22 showed a substantial decline from a median of 77.6 (IQR: 19.0) to 21.5 (IQR: 13.4), p < 0.0001. Visual Analog Scale (VAS) scores for nasal congestion improved significantly from 8.4 (IQR: 1.1) to 1.7 (IQR: 1.2), p < 0.0001. Tympanogram scores improved from Tympanogram type “B” to Tympanogram type “A” (p = 0.018). COMOT-15 scale decreased from a median of 51.3 (IQR: 8.4) to 19.2 (IQR: 5.0) (p < 0.0001). Peripheral eosinophil counts remained unchanged or increased (baseline 0.80 vs. 0.84 cells/μL at six months, (p = 0.834)). Conclusions: Dupilumab treatment in patients with CRSwNP and EOM led to significant clinical improvements in sinonasal symptoms, middle ear function, and quality of life over six months, with no significant change in peripheral eosinophilia. Full article
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Review

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21 pages, 895 KB  
Review
Recurrence of Chronic Rhinosinusitis with Nasal Polyps After Surgery: Risk Factors, Predictive Models, and Treatment Approaches with a Focus on Western and Asian Differences
by Yi-Shyue Chen, Chi-Yu Feng, Shih-Hao Su, Yu-Han Wang, Ting-Hua Yang and Chih-Feng Lin
Medicina 2025, 61(9), 1620; https://doi.org/10.3390/medicina61091620 - 8 Sep 2025
Viewed by 498
Abstract
Background and Objectives: Chronic rhinosinusitis (CRS) frequently recurs following endoscopic sinus surgery (ESS), yet reported recurrence rates, risk factors, and treatment responses differ significantly across regions. This review aims to synthesize current evidence on recurrence patterns, predictive models, and treatment strategies, with [...] Read more.
Background and Objectives: Chronic rhinosinusitis (CRS) frequently recurs following endoscopic sinus surgery (ESS), yet reported recurrence rates, risk factors, and treatment responses differ significantly across regions. This review aims to synthesize current evidence on recurrence patterns, predictive models, and treatment strategies, with a focus on comparing Asian and Western populations. Materials and Methods: A structured narrative review was conducted by searching PubMed, Embase, and Cochrane Library from January 2010 to June 2025. A total of 116 studies were included based on predefined criteria regarding recurrence definitions, risk factors, prediction models, and postoperative management. Results: Recurrence rates ranged from 12% to 76.6%, with wide variability attributed to differences in follow-up duration and recurrence definitions. Key risk factors included tissue eosinophilia, comorbid asthma, and type 2 inflammation. Asian predictive models emphasized inflammatory biomarkers such as tissue and blood eosinophils, whereas Western models incorporated imaging, prior surgical history, and symptom burden. While biologics are widely used in the West, their adoption remains limited in Asia, where endotype-driven corticosteroid strategies are predominant. Conclusions: CRS recurrence after ESS is influenced by inflammatory endotypes, comorbidities, and regional treatment paradigms. Cross-regional differences in immune profiles and healthcare access necessitate the development of standardized definitions and validated, endotype-driven prediction tools. Tailored treatment strategies, especially for non-type 2 CRS, are essential to achieving equitable and effective care globally. Full article
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