| Summary: | Chronic rhinosinusitis (CRS) represents a common source of ill health; 11% of UK adults reported CRS symptoms in a worldwide population study (Hastan 2011). Symptoms, including nasal obstruction, nasal discharge, facial pain, anosmia and sleep disturbance, have a major impact on quality of life, reportedly greater in several domains of the SF-36 than angina or chronic respiratory disease (Gliklich 1995). Acute exacerbations, inadequate symptom control and respiratory disease exacerbation are common. Complications are rare, but may include visual impairment and intracranial infection. <br/> Two major phenotypes of CRS have been identified based on the presence or absence of nasal polyps on examination. Nasal polyps are tumour-like hyperplastic swellings of the nasal mucosa, most commonly originating from within the ostiomeatal complex (Larsen 2004). Chronic rhinosinusitis with nasal polyps (CRSwNP) is diagnosed when polyps are seen (on direct or endoscopic examination) bilaterally in the middle meatus. The acronym CRSsNP is used for the condition in which no polyps are present. <br/> Although the aetiology of CRS is not fully understood, it may involve abnormalities in the host response to irritants, commensal and pathogenic organisms and allergens, obstruction of sinus drainage pathways, abnormalities of normal mucociliary function, loss of the normal mucosal barrier or infection. Two typical profiles may be observed with respect to inflammatory mediators; in eosinophilic CRS, which is typically associated with nasal polyps, high levels of eosinophils, immunoglobulin E (IgE) and interleukin (IL)-5 may be found, while in neutrophilic CRS, more often associated with CRS without polyps, neutrophils predominate, with elevated interferon (IFN) gamma, IL-8 and tumour necrosis factor (TNF). <br/> Despite the differences in phenotype and aetiology, in clinical practice many treatments for CRS are initiated without knowledge of a patient's 'polyp status'. Even when it is known whether or not a patient with CRS has polyps, this knowledge does not always suggest adjustments to treatment. This review (and most of its companion reviews) will consider patients with and without polyps together in the initial evaluation of treatment effects. However, subgroup analyses will explore potential differences between them. <br/> The most commonly used interventions for CRS are used either topically (sprayed into the nose) or systemically (by mouth) and include steroids, antibiotics and saline.
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