Current Opinion in Otolaryngology & Head and Neck Surgery最新文献

Purpose of review: The purpose of this study is to describe why this review is timely and relevant. Endotyping, the organization of rhinologic inflammation around immunologic precepts, has evolved from a research subject to a clinically relevant tool with the advent of targeted biologics in chronic rhinosinusitis (CRS). This review highlights recent progress but also the challenges to implementing endotype-based care into routine clinical practice.

Recent findings: Describe the main themes in the literature covered by the article. Recent literature demonstrates organization of patients around multiple endotypes, most prominently Type 2, Type 1/3, pauci-inflammation, and mixed inflammatory profiles. Three principal approaches to endotyping have been widely utilized: cellular (histology-based) analysis, single-biomarker, and multibiomarkers assays. Emerging machine-learning models further enhance data-driven multibiomarkers classification. Importantly, developed endotypes demonstrate correlates with key clinical features, postoperative outcomes, and responsiveness to sinus surgery and biologic therapy.

Summary: Describe the implications of the findings for clinical practice or research. Increase use of precision biologics necessitates developing well validated endotypes to better select therapy for patients. Three major approaches - histology-based, single-biomarker, and multibiomarker strategies - are commonly employed, each with distinct advantages and limitations. Moving forward, standardization of methods, development of cost-effective testing, and rigorous clinical validation remain essential steps.

Purpose of review: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a common yet complex and heterogeneous inflammatory condition that can be refractory to standard medical and surgical treatment. Patients with refractory disease may be candidates for biologics, medications that specifically target the biomarkers associated with sinonasal inflammation. The purpose of this review is to review the current literature regarding the appropriate use of biologics in the management of CRSwNP.

Recent findings: There are three currently approved biologics in the management of CRSwNP, dupilumab, omalizumab, and mepolizumab. Each biologic has demonstrated clinical efficacy in the management of CRSwNP. Current guidelines from multiple professional institutions recommend considering biologics in patients with refractory CRSwNP who have either undergone or are unable to undergo sinus surgery. Patients should be monitored closely for biologic-related adverse events and treatment response 6 months after therapy should be assessed. In poor responders to biologic therapy, alternative biologics or revision surgery can be considered.

Summary: Biologic therapy has demonstrated efficacy in the management of CRSwNP that is refractory to standard medical and surgical therapy and may be a good treatment option in this patient population.

Purpose of review: Sinonasal mucus biomarkers have emerged as a powerful, noninvasive tool to better understand the immunopathology of chronic rhinosinusitis (CRS). This review highlights the evolving role of mucus biomarkers as they move from discovery-phase research toward potential clinical implementation and identifies critical gaps that must be addressed before their integration into routine decision-making.

Recent findings: Mucus biomarkers provide valuable insights into CRS endotypes, disease severity, olfactory dysfunction, and potentially biologic choice. Recent studies have shown associations between mucus cytokine and protein profiles with postoperative olfactory recovery, polyp recurrence, and responsiveness to biologic therapy. Advances in collection devices hold potential to standardize sampling methods, while machine learning approaches are increasingly being applied to high-dimensional biomarker datasets, improving the ability to predict outcomes and guide therapy selection. Despite these advances, unresolved challenges include optimal sampling site, assay standardization, and prospective validation in clinical trials.

Summary: Mucus biomarkers are transforming our understanding of CRS by linking local immune dysfunction with clinical manifestations, such as quality-of-life impairment, olfactory loss, and disease recurrence. With continued refinement, integration of mucus biomarker profiling with machine learning and clinical datasets may enable precision diagnostics and personalized treatment strategies for CRS.

Purpose of review: This review explores the pathogenesis, diagnosis, and treatment of cough caused by rhinitis and related conditions, emphasizing new advancements.

Recent findings: Upper airway cough involves multiple inflammatory and neurogenic mechanisms, including postnasal drip stimulation of cough receptors, inflammatory mediator release, and sensory neural hypersensitivity. Diagnosis requires comprehensive clinical evaluation, with increasing emphasis on identifying specific disease endotypes. Management has expanded from conventional therapies to include biologics and targeted procedures, while emerging treatments provide additional options for refractory cases.

Summary: Chronic cough frequently results from upper airway conditions, including allergic rhinitis, nonallergic rhinitis, chronic rhinosinusitis, and postviral cough. Diagnosis and treatment depend on symptom assessment, endoscopy, imaging, and biomarkers. Management targets the underlying etiology through pharmacotherapy, immunotherapy, and procedural interventions; however, further research remains essential to optimize understanding and treatment of affected patients.

Purpose of review: Currently, no universally accepted definition or management strategy for chronic rhinosinusitis (CRS) and its acute exacerbations (AECRS) exists. This review aims to provide an overview of the current research in this field and to present recent advances in diagnosis and management.

Recent findings: A variant in the CDHR3 gene has been identified as a risk factor for AECRS, associated with increased viral replication, type-2 cytokine upregulation, and downregulation of Toll-like receptor mediated responses. Microbiome studies show that patients with AECRS are more likely to harbor rare microbial taxa, and most strains isolated during exacerbations form biofilms. Biologic therapies targeting type-2 inflammation have reduced exacerbation rates and decreased the need for antibiotics and systemic corticosteroids. Culture-directed antibiotics may improve longer-term endoscopic outcomes, though short-term symptom and quality-of-life benefits remain unclear. Cost-effectiveness modeling suggests observation is usually the most efficient initial strategy, unless the probability of bacterial etiology exceeds ~49%. In addition, a new patient-informed definition of AECRS has been proposed, although further validation is needed.

Summary: Advances in genetics, microbiome analysis, and biologic therapy offer promising avenues, yet definitions and outcome measures remain inconsistent. Robust, long-term studies are still needed to harmonize definitions and standardize management.

Purpose of review: Increasing evidence suggests that epigenetic regulation plays a central role in chronic rhinosinusitis pathogenesis, heterogeneity, and treatment response. This review summarizes current knowledge of epigenetics in CRS pathogenesis, their role in endotype differentiation, and potential as diagnostic and therapeutic targets.

Recent findings: Distinct epigenetic signatures have been identified across CRS subtypes. Hypermethylation of TSLP and differential regulation of FZD5, IL8, and EMT-related genes distinguish eosinophilic CRSwNP from other phenotypes. Specific microRNAs (miR-941, miR-21, miR-125b, miR-155) correlate with disease severity, tissue eosinophilia, and corticosteroid responsiveness, highlighting their utility as noninvasive biomarkers. Experimental data suggest that targeting DNMTs or HDACs may reverse pathogenic remodeling. Emerging therapeutic approaches - such as biologics modulating epigenetically controlled cytokines (e.g. tezepelumab) and engineered extracellular vesicle-based miRNA delivery - illustrate translational promise.

Summary: Epigenetic mechanisms critically influence CRS pathogenesis and clinical variability. Their modulation offers novel opportunities for biomarker discovery, disease stratification, and personalized therapy. Future research should focus on standardizing epigenetic profiling methodologies, validating candidate biomarkers in diverse populations, and integrating multiomics and single-cell approaches to uncover cell-specific regulatory networks. These advances may enable precision medicine in CRS, bridging the gap between molecular mechanisms and targeted clinical management.

Purpose of review: This article synthesises the recent sinus microbiome literature, identifying common themes in research findings as well as surveying the varied methodological approaches used across these studies.

Recent findings: While there remains no clear consensus as to which microbes define dysbiosis in chronic rhinosinusitis (CRS), certain trends are emerging. Increasingly, the evidence points towards a pathogenic role in the overabundance of Moraxella , Haemophilus and Pseudomonas species, whilst the genera Cutibacterium, Anaerococcus and Dolosigranulum tend towards commensalism. However, the roles of the most common genera in the sinus microbiome, Staphylococcus and Corynebacterium, remain uncertain. Given the diversity and abundance of species within these genera, species and function-level analyses are needed to clarify their contributions to the aetiopathogenesis of CRS. Comprehensive study of the sinus microbiome in healthy individuals further shows that community composition shifts with age, suggesting that dysbiosis may manifest differently across the lifespan. Beyond bacteria, growing evidence highlights the importance of fungi and viruses, underscoring the need to incorporate these microbionts into future analyses.

Summary: Progress towards a clinically meaningful consensus will require standardised approaches to sequencing, species-level resolution in these analyses, and consideration of the heterogeneous clinical and immunological subgroups of CRS.

Purpose of review: In this review, we summarize the current state of medical treatment for cystic fibrosis (CF) patients and how cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy has revolutionalized the landscape of CF management, including from a sinonasal perspective. We describe the indications for endoscopic sinus surgery (ESS), perioperative decisions otolaryngologists must consider, and the most effective surgical treatment approaches.

Recent findings: Effective CFTR modulator therapy reduces SNOT-22 scores as well as endoscopic and radiographic scores. In this era, surgical indications for people with CF and chronic rhinosinsusitis (CRS) includes persistent, recalcitrant symptoms despite medical interventions, including CFTR therapy. The decision to pursue surgery should incorporate sinus symptoms, as ESS solely for pulmonary function improvement remains controversial. When ESS is performed, extended approaches to the sinuses may be beneficial, although evidence in this area is limited.

Summary: Despite prominent advances in disease modifying therapies, ESS remains a treatment option to manage refractory sinonasal symptoms and CRS in people with CF who do not respond to medical therapy. The decision to pursue ESS remains individualized and should involve a multidisciplinary discussion between clinicians to optimize patient selection, surgical goals, and perioperative medical management.

Purpose of review: This review highlights current management strategies for recurrent nasopharyngeal carcinoma (NPC) and their balance between efficacy and toxicity.

Recent findings: Optimal management of recurrent NPC requires individualized, multidisciplinary decisions that consider not only oncologic control but also functional outcomes and toxicity. Advances in imaging and Epstein--Barr virus DNA monitoring are improving early detection and risk stratification, helping tailor salvage approach to patient and disease factors. Recent evidences also shows that severe toxicity is not only modality-dependent but is shaped by patient and disease-related factors.

Summary: Endoscopic nasopharyngectomy achieves the best outcomes in resectable cases, with higher survival and lower morbidity than re-irradiation (re-RT). Extended resections are feasible only in selected cases. Re-RT, particularly with hyperfractionated intensity-modulated RT or proton therapy, remains essential for unresectable tumors but demands careful patient selection and vigilant management of late adverse effects. Systemic therapy has uncertain benefit, while immunotherapy is mostly effective in metastatic disease. Nodal recurrence is mainly managed with neck dissection, with prognosis shaped by extranodal spread and recurrence type.

Purpose of review: Intraorbital tumors present unique surgical challenges due to their proximity to critical neurovascular structures. This review examines current surgical approaches, emerging techniques, and outcomes in the management of these complex lesions.

Recent findings: Minimally invasive endoscopic approaches have expanded treatment options, particularly for medially and inferiorly located tumors. Classification systems such as CHEER and ORBIT now guide surgical planning based on anatomic location. Integration of image guidance, three-dimensional modeling, radiomics, and early reports of robotic assistance are promising adjuncts improving preoperative assessment and surgical precision.

Summary: Surgical management of intraorbital tumors has evolved significantly, with both traditional and endoscopic approaches achieving high rates of tumor control and functional preservation. A multidisciplinary approach, individualized surgical planning, and careful patient selection are essential for optimal outcomes.