Chronic rhinosinusitis (CRS) encompasses a heterogeneous group of debilitating chronic inflammatory sinonasal diseases. Despite considerable research, the etiology of CRS remains poorly understood, and debate on potential roles of microbial communities is unresolved. Modern culture-independent (molecular) techniques have vastly improved our understanding of the microbiology of the human body. Recent studies that better capture the full complexity of the microbial communities associated with CRS reintroduce the possible importance of the microbiota either as a direct driver of disease or as being potentially involved in its exacerbation. This review presents a comprehensive discussion of the current understanding of bacterial, fungal, and viral associations with CRS, with a specific focus on the transition to the new perspective offered in recent years by modern technology in microbiological research. Clinical implications of this new perspective, including the role of antimicrobials, are discussed in depth. While principally framed within the context of CRS, this discussion also provides an analogue for reframing our understanding of many similarly complex and poorly understood chronic inflammatory diseases for which roles of microbes have been suggested but specific mechanisms of disease remain unclear. Finally, further technological advancements on the horizon, and current pressing questions for CRS microbiological research, are considered.

中文翻译：

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慢性鼻-鼻窦炎和对慢性炎性粘膜病微生物生态学的不断发展的理解。

慢性鼻-鼻窦炎（CRS）涵盖了一系列使人衰弱的慢性炎症性鼻窦疾病。尽管进行了大量研究，但对CRS的病因学知之甚少，关于微生物群落潜在作用的争论仍未解决。不依赖于文化的现代（分子）技术极大地提高了我们对人体微生物学的理解。最近的研究更好地捕捉了与CRS相关的微生物群落的全部复杂性，这再次说明了微生物群作为疾病的直接驱动者或潜在地参与疾病恶化的重要性。这篇评论全面讨论了目前对细菌，真菌和病毒与CRS的关联的了解，尤其着眼于微生物研究中现代技术向近年来提供的新观点的转变。深入讨论了这种新观点的临床意义，包括抗菌药的作用。虽然主要是在CRS的背景下进行的，但本次讨论也提供了一个类似的方法，用于重新诠释我们对许多类似复杂和了解甚少的慢性炎症性疾病的理解，对于这些疾病，人们已经提出了微生物的作用，但尚不清楚疾病的具体机制。最后，考虑了地平线上的进一步技术进步以及CRS微生物研究的当前紧迫问题。虽然主要是在CRS的背景下进行的，但本次讨论也提供了一个类似的方法，用于重新诠释我们对许多类似复杂和了解甚少的慢性炎症性疾病的理解，对于这些疾病，人们已经提出了微生物的作用，但尚不清楚疾病的具体机制。最后，考虑了地平线上的进一步技术进步以及CRS微生物研究的当前紧迫问题。虽然主要是在CRS的背景下进行的，但本次讨论也提供了一个类似的方法，用于重新诠释我们对许多类似复杂和了解甚少的慢性炎症性疾病的理解，对于这些疾病，人们已经提出了微生物的作用，但尚不清楚疾病的具体机制。最后，考虑了地平线上的进一步技术进步以及CRS微生物研究的当前紧迫问题。