From Chronic Infection to Microbial Imbalance: Rethinking Chronic Rhinosinusitis
- 1Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland
- 2Maxillofacial Surgery Department, 4th Military Clinical Hospital, Weigla 5, 50-981 Wroclaw, Poland
- 3Department of Head and Neck Oncological Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
Abstract
Chronic rhinosinusitis (CRS) has traditionally been viewed as a chronic inflammatory disease in which microbial factors are implicated. However, increasing evidence suggests that CRS may be better understood as a disruption of sinonasal microbial homeostasis rather than as a chronic infection caused by a single pathogen. This review summarizes current knowledge on healthy sinonasal microbiome composition and function as well as microbial alterations in CRS. Particular attention is given to dysbiosis involving potentially pathogenic microorganisms, including Staphylococcus aureus and Pseudomonas aeruginosa, as well as biofilm formation and its interactions with the epithelial barrier and host immune response. We also discuss host-related, therapeutic, hormonal, and environmental factors that may contribute to microbial imbalance. Current evidence does not clearly establish whether dysbiosis is a cause or consequence of chronic inflammation. Based on the evidence synthesized here, we propose that CRS may be understood as a dynamic, bidirectional interaction between microbial imbalance and chronic inflammation, whereby microbial alterations may contribute to epithelial and immune dysregulation, while changes in the host environment influence the sinonasal ecosystem. By integrating these microbiological and host-related perspectives, this review provides a boarder framework for understanding CRS pathophysiology and guiding future research into individual patterns of sinonasal microbial homeostasis.
Related
- Increased expression of hPGDS‑PGD2 in patients with eosinophilic chronic rhinosinusitis with nasal polyps
- Ocular Surface Findings in Patients with Surgery-Indicated Chronic Rhinosinusitis with Nasal Polyps: A Retrospective Study
- Endotype and Sample Site-Related Periostin Upregulation in Chronic Rhinosinusitis with Nasal Polyposis: A Systematic Review
- Interleukin-17 in the Nasal Polyps of Patients with Chronic Rhinosinusitis Compared to Healthy Controls: A Systematic Review
- Real‐World Treatment Escalation Patterns of Biologics and Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis (CRS): A Nationwide Database Study
BibTeX
@article{labaz2026from,
title = {{From Chronic Infection to Microbial Imbalance: Rethinking Chronic Rhinosinusitis}},
author = {Jakub Piotr Łabaz and Martyna Guth and Jakub Szymon Kaleta and Julia Kaczmarek and Malwina Kinczel and Karolina Kornak and Marta Kaczor and Anna Leszczyszyn and Karolina Dorobisz and Katarzyna Pazdro-Zastawny},
journal = {International Journal of Molecular Sciences},
year = {2026},
month = oct,
doi = {10.3390/ijms27209170},
url = {https://www.mdpi.com/1422-0067/27/20/9170},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From Chronic Infection to Microbial Imbalance: Rethinking Chronic Rhinosinusitis
AU - Jakub Piotr Łabaz
AU - Martyna Guth
AU - Jakub Szymon Kaleta
AU - Julia Kaczmarek
AU - Malwina Kinczel
AU - Karolina Kornak
AU - Marta Kaczor
AU - Anna Leszczyszyn
AU - Karolina Dorobisz
AU - Katarzyna Pazdro-Zastawny
PY - 2026
DA - 2026/10/01
JO - International Journal of Molecular Sciences
DO - 10.3390/ijms27209170
UR - https://www.mdpi.com/1422-0067/27/20/9170
AB - Chronic rhinosinusitis (CRS) has traditionally been viewed as a chronic inflammatory disease in which microbial factors are implicated. However, increasing evidence suggests that CRS may be better understood as a disruption of sinonasal microbial homeostasis rather than as a chronic infection caused by a single pathogen. This review summarizes current knowledge on healthy sinonasal microbiome composition and function as well as microbial alterations in CRS. Particular attention is given to dysbiosis involving potentially pathogenic microorganisms, including Staphylococcus aureus and Pseudomonas aeruginosa, as well as biofilm formation and its interactions with the epithelial barrier and host immune response. We also discuss host-related, therapeutic, hormonal, and environmental factors that may contribute to microbial imbalance. Current evidence does not clearly establish whether dysbiosis is a cause or consequence of chronic inflammation. Based on the evidence synthesized here, we propose that CRS may be understood as a dynamic, bidirectional interaction between microbial imbalance and chronic inflammation, whereby microbial alterations may contribute to epithelial and immune dysregulation, while changes in the host environment influence the sinonasal ecosystem. By integrating these microbiological and host-related perspectives, this review provides a boarder framework for understanding CRS pathophysiology and guiding future research into individual patterns of sinonasal microbial homeostasis.
SN - 1422-0067
ER -