Comparing Medical and Surgical Management of Chronic Rhinosinusitis: A Systematic Review of Dupilumab and Endoscopic Sinus Surgery

Abstract

Chronic rhinosinusitis (CRS) is a multifactorial condition that significantly impacts patients' quality of life through persistent nasal obstruction, loss of smell, and facial pain. Endoscopic sinus surgery (ESS) has historically been the definitive option for patients who fail first-line therapies, yet emerging evidence suggests that Dupixent (dupilumab), an IL-4/IL-13 inhibitor, may provide robust medical management by directly targeting the underlying type 2 inflammatory pathways. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, examining randomized clinical trials and prospective intervention studies identified through multiple databases. Findings indicate that both ESS and Dupixent can substantially improve symptoms and overall quality of life in patients with CRS. Surgical intervention offers rapid anatomical relief of nasal obstruction and may reduce bacterial biofilm prevalence, but improvements in olfactory outcomes are often limited, especially in non-polyp patients. Meanwhile, Dupixent consistently demonstrated significant reductions in nasal polyp burden, SNOT-22 scores, and enhanced olfactory function, particularly in those with pronounced type 2 inflammation. However, questions remain regarding its long-term safety, tolerability, and financial feasibility, given its ongoing nature and high cost. This review underscores the complementary roles of medical and surgical therapies: Dupixent addresses the inflammatory aspect of CRS, while ESS corrects anatomical blockages and improves local medication delivery. Ultimately, patient-specific factors-including comorbid conditions, severity of polyposis, response to first-line therapies, and cost considerations-should guide treatment selection. Ongoing large-scale trials and head-to-head comparisons will be pivotal in deciding optimal management strategies for chronic rhinosinusitis with nasal polyps (CRSwNP) and refining personalized treatment approaches.