Chronic rhinosinusitis: endotypes and personalized medicine
DOI: 10.32364/2587-6821-2026-10-8-8
Chronic rhinosinusitis: endotypes and personalized medicine
V.V. Shilenkova
Yaroslavl State Medical University, Yaroslavl, Russian Federation
Chronic rhinosinusitis (CRS) is a heterogeneous disease based on complex pathogenic mechanisms in which immunological processes and genetic factors play a central role. The condition results from a dysfunctional interplay between adverse environmental exposures and the immune system, mucosal barrier disruption, and tissue remodeling. Beyond the two principal clinical phenotypes (CRS with nasal polyps and CRS without nasal polyps) multiple additional phenotypes and subphenotypes are recognized, driven by primary immunodeficiencies, systemic diseases, vasculitides, odontogenic pathology, and other conditions. CRS is therefore best conceptualized as a spectrum of disorders with distinct molecular mechanisms, making phenotyping the cornerstone of rational therapy.
The heterogeneity of clinical presentation and pathogenesis in CRS necessitates a departure from one-size-fits-all treatment. A pathogenesis-guided approach, rather than unified protocols, allows clinicians to target the root cause of inflammation rather than its symptoms. Mandatory phenotyping with identification of disease endotypes is a prerequisite for effective management, as it enables identification of the dominant inflammatory pathway and targeted intervention at specific links of the inflammatory cascade.
Individual disease characteristics (including the presence of nasal polyps, comorbid bronchial asthma, and allergic rhinitis) are critical for rational pharmacotherapy selection. Identification of specific biomarkers, such as serum eosinophil count and IgE levels, provides a reliable basis for prescribing systemic or topical corticosteroids and, in treatment-resistant cases, biologic agents. Implementation of this approach in clinical practice is expected to prolong remission, substantially reduce the risk of exacerbations and the need for surgical intervention, and thereby improve the quality of life of patients with CRS. Assessment of disease duration and exacerbation frequency facilitates patient stratification by severity and prediction of therapeutic response. Integration of modern diagnostic algorithms into routine clinical practice thus represents a strategic direction for achieving long-term disease control.
Keywords: chronic rhinosinusitis, nasal polyps, mycetoma, odontogenic rhinosinusitis, tumor-associated rhinosinusitis, chronic sinus atelectasis, mometasone furoate.
For citation: Shilenkova V.V. Chronic rhinosinusitis: endotypes and personalized medicine. Russian Medical Inquiry. 2026;10(8):–580 (in Russ.). DOI: 10.32364/2587-6821-2026-10-8-8
About the author:
Viktoria V. Shilenkova — Dr. Sc. (Med.), Professor, Professor of the Department of Otorhinolaryngology, Yaroslavl State Medical University; 5, Revolyutsionnaya str., Yaroslavl, 150000, Russian Federation; ORCID iD 0000-0001-8553-0489
Contact information: Viktoria V. Shilenkova, e-mail: v.shilenkova@mail.ru
Financial Disclosure: the author has no financial interest in the materials or methods presented.
There is no conflict of interest.
Received 02.06.2026.
Revised 24.06.2026.
Accepted 20.07.2026.
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19. Veloso-Teles R., Cerejeira R. Endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps: Clinical outcome and predictive factors of recurrence. Am J Rhinol Allergy. 2017;31:56–62. DOI: 10.2500/ajra.2017.31.4402
20. Bachert C., Marple B., Schlosser R.J. et al. Adult chronic rhinosinusitis. Nat Rev Dis Primers. 2020;6:86. DOI: 10.1038/s41572-020-00218-1
21. Remenschneider A.K., Scangas G., Meier J.C. et al. EQ-5D-derived health utility values in patients undergoing surgery for chronic rhinosinusitis. Laryngoscope. 2015;125:1056–1061. DOI: 10.1002/lary.25054
22. Kato A., Schleimer R.P., Bleier B.S. Mechanisms and pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol. 2022;149:1491–1503. DOI: 10.1016/j.jaci.2022.02.016
23. Akdis C.A. The epithelial barrier hypothesis proposes a comprehensive understanding of the origins of allergic and other chronic noncommunicable diseases. J Allergy Clin Immunol. 2022;149:41–44. DOI: 10.1016/j.jaci.2021.11.010
24. Yan B., Lan F., Li J. et al. The mucosal concept in chronic rhinosinusitis: Focus on the epithelial barrier. J Allergy Clin Immunol. 2024;153:1206–1214. DOI: 10.1016/j.jaci.2024.01.015
25. Шиленкова В.В., Шиленков К.А. EPOS-2020. Что нового? Российская ринология. 2020;28(2):94–100. DOI: 10.17116/rosrino20202802194. Shilenkova V.V., Shilenkov K.A. EPOS-2020. What's new? Russian Rhinology. 2020;28(2):94–100 (in Russ.). DOI: 10.17116/rosrino20202802194
26. Xie X., Xuan L., Zhao Y. et al. Diverse endotypes of chronic rhinosinusitis and clinical implications. Clin Rev Allergy Immunol. 2023;65:420–443. DOI: 10.1007/s12016-023-08976-y
27. Wang M., Li Y., Li J. et al. New insights into the endotypes of chronic rhinosinusitis in the biologic era. J Allergy Clin Immunol. 2025;156(1):51–60. DOI: 10.1016/j.jaci.2025.02.015
28. Toppila-Salmi S., Reitsma S., Hox V. et al. Comorbid Chronic Rhinosinusitis and Asthma: Shared Risk Factors and Treatment Implications-An EAACI Task Force Report. Allergy. 2026;81(4):1000–1023. DOI: 10.1111/all.70237
29. Cho S.H., Hamilos D.L., Han D.H., Laidlaw T.M. Phenotypes of Chronic Rhinosinusitis. J Allergy Clin Immunol Pract. 2020;8(5):1505–1511. DOI: 10.1016/j.jaip.2019.12.021
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