Chronic Sinusitis: A Comprehensive Review of Etiology, Diagnosis, and Modern Management

Chronic rhinosinusitis (CRS) is a common pericranial inflammatory disease of the paranasal sinuses lasting greater than 12 weeks, which affects millions of people around the world. This review describes the multifactorial etiology of CRS, advances in CRS diagnostics, and new treatment options. The causes of CRS include anatomical obstruction, infections (microbial), allergies, and an unintended, inappropriate, and exaggerated immune response. In recent literature, the importance of biofilms, genetic background, and imbalance of the microbiome has also been examined. Therapy is composed of medical therapies (e.g., intranasal corticosteroids, antibiotics, and biologics) and surgery, including the increasingly popular functional endoscopic sinus surgery (FESS) and other types of surgical airway reconstruction. New ideas and therapies have emerged, including therapies targeting the ecosystem of the microbiome (including next-generation sequencing) and biologics, including dupilumab. The purpose of this review is to highlight diagnostic criteria, treatment options, and new therapies. By presenting current problems and new directions for research, we hope to assist clinicians and researchers to give their patients with CRS the best chance for improved outcomes.