Rewriting the Rules of Rhinosinusitis

Additional research may change the equation. Now, it is generally less expensive to treat CRS with polyps with surgery, “even if you have to do multiple surgeries and combine surgical treatment with topical medical therapies,” Dr. Turner said, than to utilize biologic medication. The discovery of specific biomarkers may eventually allow physicians to diagnose and treat CRS—with or without polyps—based on endotype rather than phenotype. And if research ultimately reveals that it’s possible to de-escalate biologic treatment over time, without decreasing the efficacy of treatment, the cost (financial and otherwise) of biologic therapy may decrease to the point that it may reasonably be considered as first-line therapy in some cases.

“If you change the dosing schedule from every two or every four weeks to every eight or 12 weeks, you’ve completely changed the economic model for the decision tree,” Dr. Turner said, noting that some published studies have already suggested that extending the dosing schedule of dupilumab does not appear to negatively affect symptom control (Laryngoscope. 2025;135:2267- 2274; Allergy. 2023;78:2684-2697).

As research continues to clarify the mechanisms and markers of sinus disease, treatment decisions will keep evolving. The 2025 guidelines for the medical and surgical management of adult sinusitis provide a clear framework for evidence-based, patient-centered care. For otolaryngologists, they reinforce best practices while challenging clinicians to communicate updated treatment protocols to patients and colleagues in primary and urgent care.

Key Changes in the 2025 Sinusitis Guidelines

• Watchful waiting is now the first-line for all uncomplicated acute bacterial rhinosinusitis.
• Biologics restricted to CRS with nasal polyps; not recommended for CRS without polyps.
• No required “step therapy” before surgery; antibiotics or steroids aren’t mandatory prerequisites for endoscopic sinus surgery.
• Post-operative care standardized: follow-up at three to 12 months, with structured outcome assessment and patient counseling

Jennifer Fink is a freelance medical writer based in Wisconsin.