It is increasingly recognized that chronic rhinosinusitis (CRS) comprises a spectrum of different diseases with distinct clinical presentations and pathogenic mechanisms. Defining the distinct phenotypes and endotypes of CRS affects prognosis and, most importantly, is necessary as the basis for making therapeutic decisions. The need for individualized definitions of pathogenic mechanisms before initiating therapy extends to virtually all therapeutic considerations. This is clearly crucial with antibiotics, where, barring an influence from their off-target anti-inflammatory pharmacologic effects, an understanding of the role of the individual biome predicts likelihood of therapeutic benefit. However, this need for identifying individual phenotypes and endotypes also extends to the agent that is currently considered the mainstay of treatment of CRS, specifically glucocorticoids. As with asthma, it is recognized that a large minority of patients with CRS have a steroid-resistant phenotype, identification of which will preclude use of these agents with their potential side effects. Identification of endotypes is also becoming increasingly imperative because targeted biotherapeutic agents, such as anti-IgE and anti-cytokine antibodies, are becoming available. These agents are likely to benefit patients in whom the targeted mediator is not only expressed but demonstrably driving a central mechanism in that patient. In summary, the treatment of CRS is at an exciting crossroad. On the positive side, numerous therapeutics are in development that seem likely to have a positive effect in our patients with this condition. The challenge is that these therapies will require targeted individualized treatments based on identifying subjects with the relevant endotype.

越来越多的人认识到，慢性鼻鼻窦炎（CRS）包括一系列不同的疾病，具有不同的临床表现和致病机理。定义CRS的不同表型和内型会影响预后，最重要的是，作为制定治疗决策的基础是必要的。在开始治疗之前，对致病机制的个体化定义的需求实际上已扩展到所有治疗考虑因素。这显然对抗生素至关重要，在抗生素中，除非受到脱靶抗炎药理作用的影响，对单个生物群落的作用的理解会预测出治疗益处的可能性。但是，识别个体表型和内型的需求也扩展到目前被认为是治疗CRS的主要手段的药物，特别是糖皮质激素。与哮喘一样，公认的是，大多数CRS患者具有类固醇抵抗性表型，对其进行鉴定将阻止使用这些药物及其潜在副作用。由于靶向生物治疗剂（例如抗IgE和抗细胞因子抗体）的可获得性，内型的鉴定也变得越来越重要。这些药物可能有益于目标表达介质不仅表达而且在该患者中具有驱动中枢机制的患者。总之，CRS的治疗正处于令人兴奋的十字路口。从积极的方面来看，正在开发许多疗法，这些疗法似乎可能会对这种情况的患者产生积极的作用。