From evidence to practice: considerations in the treatment of CRS.

BACKGROUND Chronic rhinosinusitis (CRS) significantly impacts quality of life (QoL). Understanding type 2 inflammation and biologics introduction have expanded treatment options. However, the real-world application of these strategies remains complex, as patient heterogeneity, and comorbidities frequently challenge algorithmic approaches. Aims/Objectives: To examine current practices in CRS, evaluate their limitations, and propose principles of good clinical practice. Methods: A narrative review of contemporary guidelines, and clinical studies was performed. Core themes include the use of corticosteroids, surgical interventions and revision criteria, aspirin therapy after desensitisation (ATAD), biologics, adherence to basic therapies, and the balance between algorithms and professional judgement. Results: Intranasal corticosteroids (INCS) and saline irrigations remain the cornerstone of CRS management, though poor adherence. Endoscopic sinus surgery (ESS) provides improvements but with variable outcomes beyond expert medical centres. Biologics represent a major breakthrough for selected patients, yet cost, accessibility, and uncertainty regarding treatment duration. ATAD retain value in specific phenotypes. Across all, reliance on algorithms alone risks oversimplification, highlighting the importance of clinical expertise, diagnostic reassessment, and patient involvement. Conclusions and Significance: Good clinical practice in CRS requires patient-centred care, integration of comorbidities, adherence to basic therapies, and a judicious use of advanced interventions, reconciling algorithmic guidance with professional judgement.

AIMS/OBJECTIVES To examine current therapeutic practices in CRS, evaluate their limitations, and propose principles of good clinical practice that place the patient at the centre of care.

METHODS A narrative review of contemporary guidelines, consensus statements, and high-impact clinical studies was performed. Core themes include the use of corticosteroids, surgical interventions and revision criteria, aspirin therapy after desensitisation (ATAD), biologics, adherence to basic therapies, and the balance between algorithms and professional judgement.

RESULTS Intranasal corticosteroids (INCS) and saline irrigations remain the cornerstone of management for most patients, though poor adherence limits their effectiveness. Endoscopic sinus surgery (ESS) provides improvements but with variable outcomes beyond expert medical centres. Biologics represent a major breakthrough for selected patients with uncontrolled disease, yet cost, accessibility, and uncertainty regarding treatment duration constrain their widespread use. ATAD and other underutilised options retain value in specific phenotypes. Across all modalities, reliance on algorithms alone risks oversimplification, highlighting the importance of clinical expertise, diagnostic reassessment, and patient involvement in shared decision-making.

CONCLUSIONS AND SIGNIFICANCE Good clinical practice in CRS requires more than adherence to guidelines. Patient-centred care, integration of comorbidities, reinforcement of adherence to basic therapies, and the judicious use of advanced interventions are essential. The future of CRS management lies in reconciling algorithmic guidance with professional judgement to deliver care that is effective, equitable, and sustainable.