[Chronic rhinosinusitis. What is new from the last 25 years?].

Chronic rhinosinusitis (CRS) appears to be of increasing relevance epidemiologically. Despite progress in elucidating the role of eosinophilia as well as aspirin intolerance and eicosanoid mediators, the pathophysiology remains obscure. Endonasal sinus surgery has become the treatment of the choice for CRS patients with and without nasal polyposis, particularly if conservative treatment fails. Long-term studies indicate that a minimally invasive approach with microscopic and endoscopic procedures is preferable to radical surgery. Powered instrumentation or computer-aided surgery are still controversially discussed, but certainly can be very helpful in the hands of an experienced surgeon, especially to minimize surgical trauma and save surgical time. The complex therapeutic concept needs to be individually tailored to the disease of the patients and to the heterogeneous etiologic aspects.