Eosinophilic Chronic Rhinosinusitis and Nasal Polyp Management

Eosinophilic chronic rhinosinusitis (ECRS) is a subtype of chronic rhinosinusitis marked by persistent type 2 inflammation, dense eosinophil infiltration and formation of nasal polyps. Patients typically present with nasal obstruction, anosmia and mucosal oedema that often recur despite medical and surgical interventions. Pathophysiology involves dysregulated epithelial barrier function, cytokine networks dominated by interleukin-5, interleukin-4 and interleukin-13, and chemokines such as eotaxins that recruit eosinophils into sinus tissue. Standard management combines intranasal and systemic corticosteroids to suppress inflammation, functional endoscopic sinus surgery to restore ventilation and drainage, and, for selected patients, biological therapies targeting IL-5 or IgE. Emerging strategies emphasise personalised treatment based on tissue phenotyping, environmental risk mitigation and predictive modelling to reduce recurrence and improve quality of life.

Research from Nature Portfolio

Recent work has identified a novel mechanism by which dysregulated lipid mediators undermine innate immune regulation of eosinophilic inflammation. Investigators demonstrated that elevated prostaglandin D2 within sinonasal tissues suppresses natural killer cell effector functions, impairing NK-cell-mediated apoptosis of eosinophils and thereby promoting tissue eosinophilia. In experimental models, depletion of NK cells exacerbated blood and tissue eosinophilia, while blockade of PGD2 pathways partially restored NK-cell activity. This insight reveals a previously unrecognised link between prostaglandin metabolism and eosinophilic persistence in chronic rhinosinusitis, highlighting potential targets for restoring immune homeostasis.

Eosinophilic Chronic Rhinosinusitis and Nasal Polyp Management publication trend

The graph below shows the total number of articles in eosinophilic chronic rhinosinusitis and nasal polyp management across all publications each year (not limited to Nature Index journals).

Technical terms

Eosinophils: A type of white blood cell involved in type 2 immune responses, contributing to tissue inflammation and polyp formation.

Type 2 inflammation: An immune response characterised by cytokines such as interleukin-4, interleukin-5 and interleukin-13, driving eosinophilic recruitment in chronic airway diseases.

Chronic rhinosinusitis: Persistent inflammation of the nasal and sinus mucosa lasting over 12 weeks, often leading to nasal obstruction and discharge.

Nasal polyps: Benign inflammatory outgrowths of the sinus mucosa commonly associated with eosinophilic inflammation and olfactory dysfunction.

Endoscopic sinus surgery: A minimally invasive surgical technique to restore sinus ventilation and remove obstructive polyps.

Biological therapy: Treatment using monoclonal antibodies targeting specific cytokines or receptors, such as anti-IL-5 agents, to reduce eosinophil-driven inflammation.

References

1. Pathogenesis of eosinophilic chronic rhinosinusitis. Journal of Inflammation (2016).
2. Natural killer cells regulate eosinophilic inflammation in chronic rhinosinusitis. Scientific Reports (2016).
3. Individual exposure of ambient particulate matters and eosinophilic chronic rhinosinusitis with nasal Polyps: Dose-Response, mediation effects and recurrence prediction. Environment International (2023).
4. When the Nose Meets the Lab: Histopathological Analysis in Chronic Rhinosinusitis with Nasal Polyps for Routine Clinical Practice. Current Allergy and Asthma Reports (2024).
5. Involvement of CD40-CD40L and ICOS-ICOSL in the development of chronic rhinosinusitis by targeting eosinophils. Frontiers in Immunology (2023).