Chronic rhinosinusitis with nasal polyps (CRSwNP) is a clinically heterogeneous inflammatory disorder characterized by persistent sinonasal inflammation and a notable tendency for recurrence, even in patients receiving appropriate medical and surgical treatment. This heterogeneity largely reflects differences in underlying inflammatory endotypes, which in turn influence clinical presentation, risk of postoperative relapse, and response to therapy. In the majority of patients, type 2 (T2) inflammation represents the dominant immunologic profile, driven by cytokines such as interleukin (IL)-4, IL-5, IL-13, and thymic stromal lymphopoietin (TSLP). Targeting these pathways has become a central focus in recent therapeutic strategies. In this context, the introduction of biologic agents has substantially altered the management of patients with severe and difficult-to-control disease. Data from phase 3 randomized trials have consistently shown meaningful reductions in polyp burden and symptom severity, along with decreased reliance on systemic corticosteroids and a lower need for revision surgery. These findings are supported by real-world studies, which suggest that the benefits of biologic therapies extend to more heterogeneous patient populations, including those with comorbid asthma or aspirin-exacerbated respiratory disease. Despite these advances, several important questions remain unresolved. In particular, there is a need for more precise patient selection based on reliable biomarkers, as well as clearer guidance on long-term treatment strategies. Issues related to cost-effectiveness and the optimal timing of treatment discontinuation or switching also continue to represent areas of ongoing debate in clinical practice.

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