Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham.
Department of Otolaryngology, Guy's Hospital, London, United Kingdom.
JAMA Otolaryngol Head Neck Surg. 2020 Sep 1;146(9):831-838. doi: 10.1001/jamaoto.2020.1453.
Chronic rhinosinusitis (CRS) is a broadly defined process that has previously been used to describe many different sinonasal pathologic conditions from odontogenic sinusitis and allergic fungal sinusitis to the more contemporary definition of broad inflammatory airway conditions. Previous classification systems have dichotomized these conditions into CRS with nasal polyps and CRS without nasal polyps. However, clinicians are learning more about the inflammatory subtypes of CRS, which can lead to improved delivery and effectiveness of treatment.
In clinical practice, treatment decisions are often based on observable findings, clinical history, presumed disease, and molecular pathophysiologic characteristics. A proposed classification system is simple and practical. It proposes that the functional anatomical compartments involved create the first level of separation into local and diffuse CRS, which are usually unilateral or bilateral in distribution. Diffuse does not imply "pansinusitis" but simply that the disease is not confined to a known functional anatomical unit. This classification takes into account whether local anatomical factors are associated with pathogenesis. Then the inflammatory endotype dominance is separated into a type 2 skewed inflammation, as this has both causal and treatment implications. The non-type 2 CRS encompasses everything else that is not yet known about inflammation and may change over time. The phenotypes or clinical examples are CRS entities that have been described and how they align with this system.
Although research continues to further define the subtypes of CRS into phenotypes and endotypes, the proposed classification system of primary CRS by anatomical distribution and endotype dominance allows for a pathway forward.
慢性鼻-鼻窦炎（CRS）是一个广泛定义的过程，以前曾用于描述许多不同的鼻-鼻窦病理状况，从牙源性鼻窦炎和变应性真菌性鼻窦炎到更现代的广义炎症性气道疾病的定义。以前的分类系统将这些情况分为伴有鼻息肉的 CRS 和不伴鼻息肉的 CRS。然而，临床医生对 CRS 的炎症亚型有了更多的了解，这可以提高治疗的效果和有效性。
在临床实践中，治疗决策通常基于可观察到的发现、临床病史、推测的疾病和分子病理生理特征。提出的分类系统简单实用。它提出，涉及的功能解剖隔室构成了第一个水平的分离，分为局部和弥漫性 CRS，通常分布为单侧或双侧。弥漫性并不意味着“全鼻窦炎”，只是疾病不局限于已知的功能解剖单位。这种分类考虑了局部解剖因素是否与发病机制有关。然后，将炎症表型优势分为 2 型偏倚炎症，因为这既有因果关系又有治疗意义。非 2 型 CRS 包含了所有其他尚未了解的炎症，并且可能随时间而变化。表型或临床实例是已经描述过的 CRS 实体，以及它们如何与这个系统相匹配。
尽管研究继续进一步将 CRS 的亚型细分为表型和内型，但按解剖分布和内型优势提出的原发性 CRS 分类系统为前进提供了一条途径。
