Precision Medicine in Chronic Rhinosinusitis With Nasal Polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous and multifactorial inflammatory disease of the upper airways that imposes a substantial burden on patients and healthcare systems worldwide. Surgical intervention, most commonly functional endoscopic sinus surgery (FESS), remains a cornerstone of management for patients with uncontrolled disease, yet recurrence after surgery is common and outcomes vary widely across patients. This variability is increasingly understood to reflect the fact that CRSwNP is not a single clinical entity but a syndrome encompassing multiple inflammatory endotypes driven by distinct cellular and molecular mechanisms.

While traditional surgical decision-making has relied on symptom burden, endoscopic and radiological findings, recent advances in immunology and molecular profiling have revealed the underlying diversity of inflammatory patterns, particularly the predominance of type 2 inflammation in Western populations and mixed or non-type 2 patterns elsewhere. Epithelial barrier dysfunction, innate immune activation, and tissue remodelling are now recognized as central drivers of disease chronicity and of the high revision-surgery rates seen in some endotypes.

These discoveries have prompted a paradigm shift toward biological stratification, with direct implications for surgical practice: which patients are likely to fail surgery alone, which benefit from a combined medical-surgical strategy, and how the extent and timing of surgery should be adapted to a patient’s endotype. However, the translation of endotypic characterization into surgical decision-making remains incomplete. Persistent challenges include high recurrence rates after surgery, inconsistent response to corticosteroids or biologics, unclear sequencing of surgery relative to biologic therapy, and limited availability of reliable biomarkers to guide operative planning and predict postoperative outcomes.

Consequently, there is a growing need to integrate molecular research, surgical practice, and computational analytics to achieve true precision medicine in CRSwNP management. This includes incorporating “treatable traits” frameworks into surgical decision-making, enabling clinicians to select surgical candidates, tailor extent of surgery, and time biologic initiation based on specific pathogenic pathways rather than phenotypic classification alone.

By gathering research that bridges mechanistic understanding, surgical practice, and clinical application, this Research Topic aspires to advance precision medicine approaches that improve surgical and medical treatment response, reduce disease and polyp recurrence, and enhance quality of life for patients with CRSwNP.

We encourage submissions addressing, but not limited to, the following themes:
• Molecular and cellular mechanisms defining inflammatory endotypes in CRSwNP;
• Discovery and validation of diagnostic, prognostic, and therapeutic biomarkers;
• Gene expression, proteomic, and metabolomic profiling of nasal tissue and secretions;
• Predictive factors for response to biologic therapy and corticosteroid resistance;
• Integration of multi-omics and artificial intelligence for CRSwNP classification;
• Role of sinonasal microbiota and epithelial-immune interactions in disease persistence;
• Comparative analyses of endotype prevalence across ethnic and geographic populations;
• Longitudinal studies assessing disease progression under individualized treatment regimens;
• Surgical management of CRSwNP under a precision framework, including endoscopic sinus surgery outcomes, patient stratification for primary vs. revision surgery, and the combination or sequencing of surgery with biologic therapies;
• Development of clinical algorithms and digital health tools to guide personalized interventions.

We welcome submissions, but are not limited to, in the form of Original Research, Reviews, Mini Reviews, Brief Research Reports, Case Reports, Hypothesis and Theory Articles, Perspectives, Selected Editorials and Consensus documents.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: CRSwNP, Type 2 inflammation, Inflammatory endotypes, Epithelial barrier dysfunction, Biomarkers, Precision medicine, Biologic therapy, Endoscopic sinus surgery, Tissue remodelling, Patient stratification, Postoperative recurrence

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.