Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disorder driven by dysregulated innate and adaptive immune responses. This review summarizes current evidence on the roles of T-helper cell subsets and regulatory T-cells (Tregs) in CRSwNP pathogenesis and discusses their implications for disease persistence and targeted therapy. Beyond classical Th2-driven inflammation, recent studies demonstrate important contributions from Th1, Th9, Th17, Th22, and CD8⁺ effector-memory/tissue-resident T-cells to epithelial injury, tissue remodeling, and disease recurrence. Reduced FOXP3⁺ Treg frequency and impaired function, together with alterations in IL-2, TGF-β, and IL-10 signaling, may contribute to persistent immune activation and inflammatory heterogeneity. Advances in biologic therapies targeting type 2 inflammation have substantially improved outcomes in selected patients. T-cell dysregulation is central to the immunopathogenesis of CRSwNP. A better understanding of immune endotypes, T-cell plasticity, and regulatory pathways may facilitate biomarker-guided patient stratification and support the development of more precise immunomodulatory therapies.
Allergic rhinitis (AR) is a prevalent hypersensitivity reaction to various sensitized environmental allergens. The disease has a broad range of symptoms and is diagnosed based primarily upon a thorough history. This review aims to evaluate the current and emerging treatment paradigms, including environmental avoidance, pharmacotherapy, surgical interventions, monoclonal antibodies, and immunotherapy options. There exist a multitude of different treatment options and strategies to treat allergic rhinitis. Intranasal corticosteroids and intranasal antihistamines are some of the most effective pharmacotherapy options available. Additional medications exist to help with specific symptoms or those with more severe disease. Surgical interventions can assist with structural sinonasal issues that contribute to symptomology. Allergen immunotherapy (AIT) is an effective therapy, and newer options such as intralymphatic immunotherapy and FDA approved sublingual immunotherapy tablets are emerging options for patients. Biologics, while not approved for allergic rhinitis, have shown to be effective. Allergic rhinitis is a commonly encountered disease that affects a large portion of the population. Traditional pharmacotherapy and immunotherapy options are mainstays of treatment. Newer therapies are emerging that can be useful adjuncts in treating these patients.
This review aims to provide a comprehensive overview of the current approaches to the management of unilateral vocal fold palsy (UVFP). Recent literature underscores the pivotal role of laryngeal electromyography (L-EMG) in both the diagnostic evaluation and prognostic stratification of UVFP. The acute phase is generally defined as the first 9 months following onset, whereas chronic UVFP encompasses cases persisting beyond 9 months or those associated with confirmed nerve transection. Early injection laryngoplasty is increasingly advocated to alleviate symptoms, optimize voice outcomes, and potentially reduce the need for definitive surgical interventions. Furthermore, emerging evidence highlights the favorable and durable outcomes associated with non-selective laryngeal reinnervation (NSR) procedures. In appropriately selected patients, and in the absence of contraindications, NSR represents a valuable treatment option. Optimal management of UVFP requires a phase-based approach, emphasizing early intervention during the acute stage and consideration of laryngeal framework surgery or reinnervation procedures in the chronic phase. Achieving and maintaining effective glottic closure remains the cornerstone of successful treatment. Full effort to maintain glottic competency at all times should be given. Multi-disciplinary approach with the speech and language therapy team is needed throughout the care. Full armamentarium of techniques should be available for personalized care.
