Böscke Robert
Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Evangelisches Krankenhaus Oldenburg, Medizinischer Campus der Carl-von-Ossietzky Universität Oldenburg, Steinweg 13-17, 26122, Oldenburg, Deutschland.
HNO. 2024 Apr;72(4):231-241. doi: 10.1007/s00106-024-01443-w. Epub 2024 Mar 12.
In recent years, significant improvements have been made in the treatment options for uncontrolled chronic rhinosinusitis (CRS) refractory to standard medical and surgical therapy. This is the result of a better understanding of the pathophysiology and the resulting development of biologicals for CRS with nasal polyps (CRSwNP). However, biologics are not (yet) available for all patients in Europe.
Based on the session "Difficult-to-treat CRS, when biologics are not available" at the 29th Congress of the European Rhinologic Society (ERS) 2023 in Sofia, Bulgaria, the treatment options for uncontrolled CRS with the exclusion of biologics will be discussed.
The content of the presentations "Is there a place for antibiotics?" "Indications for revision surgery," "Novel systemic treatment options," "Novel local treatment options," and "Phototherapy for nasal polyps" are outlined and supported by a review of the literature.
Various treatment options are available for managing uncontrolled CRS, even if biologic treatments are unavailable. Treatment options for type‑2 (T2) CRS include steroid rinses, repeated short-term oral steroids, steroid-eluting stents, and extended sinus surgery. In the case of nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD), acetylsalicylic acid (ASA) desensitization can be considered. Non-T2 endotypes or CRS without nasal polyps (CRSsNP) may benefit from several weeks of macrolides and xylitol rinses.
To accurately assess the efficacy of second-line therapies for treatment of difficult-to-treat CRS within an endotype-specific framework, additional controlled clinical trials are needed that take into account the heterogeneity of CRS endotypes.
近年来，对于标准药物和手术治疗无效的慢性鼻-鼻窦炎（CRS），其治疗选择有了显著改善。这是由于对病理生理学有了更好的理解，以及由此开发出了用于治疗伴有鼻息肉的CRS（CRSwNP）的生物制剂。然而，在欧洲，并非所有患者都能（目前还不能）使用生物制剂。
基于2023年在保加利亚索非亚举行的第29届欧洲鼻科学会（ERS）大会上的“生物制剂不可用时难治性CRS的治疗”会议，将讨论排除生物制剂后治疗难治性CRS的选择。
概述了“抗生素是否有一席之地？”“翻修手术的适应症”“新型全身治疗选择”“新型局部治疗选择”以及“鼻息肉的光疗”等报告的内容，并通过文献综述提供支持。
即使无法使用生物制剂治疗，仍有多种治疗选择可用于管理难治性CRS。2型（T2）CRS的治疗选择包括类固醇冲洗、重复短期口服类固醇、类固醇洗脱支架和扩大鼻窦手术。对于非甾体抗炎药（NSAID）加重的呼吸道疾病（NERD），可考虑乙酰水杨酸（ASA）脱敏治疗。非T2内型或无鼻息肉的CRS（CRSsNP）可能受益于数周的大环内酯类药物治疗和木糖醇冲洗。
为了在特定内型框架内准确评估二线疗法治疗难治性CRS的疗效，需要开展更多考虑CRS内型异质性的对照临床试验。
