Surgical management of chronic rhinosinusitis: a narrative review

Purpose: Chronic rhinosinusitis (CRS) is a common, persistent inflammatory condition of the paranasal sinuses that significantly diminishes patients' quality of life. Although medical therapy remains the initial treatment of choice, surgical intervention is frequently required for individuals who do not respond adequately to conservative management. This review aims to provide a comprehensive overview of surgical treatments for CRS, highlighting contemporary practices, indications, clinical efficacy, and outcomes.Current Concepts: Endoscopic sinus surgery (ESS) has become the standard surgical procedure for CRS, focusing on the removal of pathological lesions and the restoration of normal sinus drainage and ventilation. Recent advances in endoscopic techniques have improved both the precision and safety of ESS. A thorough understanding of sinonasal anatomy, together with meticulous preoperative planning, is essential to minimize complications and ensure successful outcomes. Postoperative care, including nasal irrigation and topical corticosteroids, plays a critical role in promoting mucosal healing and preventing disease recurrence.Discussion and Conclusion: Surgical treatment for CRS continues to evolve, providing significant symptom relief for patients who are unresponsive to medical therapy. Optimal outcomes depend on individualized surgical planning that takes into account symptom severity, radiologic findings, and patient comorbidities. As our understanding of CRS shifts toward recognizing it as an immune-mediated disease, rather than a purely infectious or obstructive process, the role of surgery has changed accordingly. Ongoing research into minimally invasive techniques, long-term outcomes, and adjunctive therapies is likely to further refine future treatment strategies. A multidisciplinary approach remains vital for improving the overall management of CRS.