The evolving role of biologics in chronic rhinosinusitis
Biologic therapies have fundamentally changed the treatment landscape for chronic rhinosinusitis with nasal polyps. This article looks at where biologics fit alongside surgery — and how that balance is shifting.
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How biologics changed the treatment conversation
For decades, functional endoscopic sinus surgery was the default next step once medical therapy failed in chronic rhinosinusitis with nasal polyps. Biologic agents targeting type 2 inflammation have introduced a genuine alternative — one that can reduce polyp burden and symptom severity without a single incision. This has shifted the conversation from "surgery versus medication" to a more nuanced question of sequencing and patient selection.
Choosing between biologics and surgery — or both
In practice, the decision is rarely binary. Some patients respond well to biologics alone; others benefit from surgery first to improve drug delivery and access, followed by biologics to maintain control. Understanding which patients fall into which category — based on polyp burden, comorbidities, and prior surgical history — is becoming an essential skill for any rhinologist.
What this means for surgical training
As biologics become more widely used, surgeons need to understand not just how to operate, but when not to — and how surgical anatomy changes in patients who have already been on biologic therapy. This evolving picture is exactly why up-to-date, faculty-led discussion of biologics belongs alongside hands-on surgical training, not apart from it.
- Biologics are now a genuine alternative to surgery for select patients
- Patient selection depends on polyp burden, comorbidities, and surgical history
- Combined approaches — surgery followed by biologics — are increasingly common
- Surgical anatomy and tissue response can differ in biologic-treated patients
