BackgroundSince 2022, several biologics are indicated and reimbursed for Belgian patients with severe uncontrolled CRSwNP despite previous endoscopic sinus surgery (ESS). Data on the impact of biologics on the number of patients undergoing revision ESS are lacking.MethodsWe analyzed the trend in numbers and percentages of patients with severe uncontrolled CRSwNP being offered primary ESS, revision ESS or biologics according to both academic- and reimbursement criteria at a tertiary care Rhinology center (University Hospitals Leuven) in Belgium, from 2019 until 2023.ResultsA total of 641 patients with severe uncontrolled CRSwNP had been offered primary/revision ESS or biologics in the past 5 years. In contrast to the overall increase in annual numbers of CRSwNP patients treated for uncontrolled CRSwNP from 2019 (n = 128) until 2023 (n = 160) by ESS or biologics, the absolute number of patients undergoing revision surgery is reduced by the advent of biologics since 2022. Patient numbers undergoing revision ESS were 66 and 59 in 2019 and 2020 respectively, and 48 in 2023. Moreover, the percentage of patients undergoing revision surgery dropped from 52% and 56% in 2019 and 2020, respectively to 34% and 30% in 2022 and 2023, respectively. The percentage of primary ESS procedures remained stable.ConclusionThe advent of biologics reduced the number and percentage of severe uncontrolled CRSwNP patients undergoing revision ESS, in contrast to number and percentage of primary ESS.

The therapeutic goal in chronic airway diseases is shifting from symptom control to disease remission. Disease-modifying therapies, including biologics and allergen immunotherapy, have made remission achievable in patients with severe asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), or allergic rhinitis (AR). This EUFOREA consensus aims to establish practical guidance for inducing and maintaining remission in global airway diseases. An international panel of experts in pneumology, rhinology, and allergology convened in Rome (October 2025) to review current evidence and develop consensus statements. The panel achieved consensus on key principles: (i) remission is a therapeutic target independent of disease severity prior to treatment initiation and should not be reserved for severe cases; (ii) CRSwNP with nonallergic eosinophilic asthma, and AR with allergic asthma should be considered features of a single disease rather than comorbidities; (iii) remission should be assessed by each subspecialty separately while warranting combined approaches; (iv) pragmatic definitions prioritizing achievability and clinical utility are recommended; and (v) a 4-week recall window is preferred to assess symptom control within the evaluation of remission and a 12-month period is suggested as the minimal period to define remission. Remission represents an ambitious yet achievable goal, with practical guidance for optimizing patient outcomes.

Background:In recent years, treatment options for patients with uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) have been expanded with biologics. Definitions of uncontrolled severe disease differ across international recommendations and the prescription of biologics depends on national reimbursement criteria. Objective:We aimed to evaluate the indication for biologic treatment, based on international recommendations, in a real-world cohort of CRSwNP patients. Methods:CRS patients who visited the outpatient ENT clinic of 10 tertiary centres from 7 European countries were invited to use the Galenus Health mobile application monitoring their disease. The proportion of patients who fulfilled biologic indication criteria according to EUFOREA 2021 and EPOS/EUFOREA 2023 recommendations was evaluated. Results:A total of 281 CRS patients were recruited of which 227 (82.1%) were diagnosed as CRSwNP. Out of these 227 patients, 21 patients with prior biologic use were excluded, resulting in a cohort of 206 patients. A total of 28.7% (50/174) and 47.6% (81/170) of CRSwNP patients, met the EUFOREA 2021 or EPOS/EUFOREA 2023 criteria for indication for biologic treatment, respectively. Biologic treatment was initiated at the time of inclusion in the cohort in 18.9% (39/206) of CRSwNP patients. Conclusion:According to international recommendations, 29-48% of CRSwNP patients in tertiary centres may be a candidate for biologic treatment. EPOS/EUFOREA2023 criteria were more inclusive than EUFOREA 2021 criteria with respect to biologic indication for CRSwNP. National reimbursement criteria prevail over international recommendations for actual biologic prescription and are less restrictive in some countries.

KEY POINTS:In recent years, several biologics targeting Type 2 inflammation have been developed for treating chronic rhinosinusitis with nasal polyps (CRSwNP). These have been studied in registrational randomized controlled trials (RCTs), which vary in their patient populations, trial design, endpoints, geography, timing, or data-handling processes. While (in)direct treatment comparisons and meta-analyses have been carried out to compare efficacy results from RCTs, often these fail to properly account for these between-study differences. Here, we summarize the key between-study differences that can influence trial outcomes and highlight the resulting challenges faced when comparing outcomes from different Phase III RCTs of biologics in CRSwNP.

Chronic respiratory diseases (CRDs) remain 1 of the leading causes of preventable morbidity and disability worldwide, affecting up to one-third of the total Western population in 2025. Recognizing the substantial burden of inflammatory airway diseases such as asthma, COPD, chronic rhinosinusitis, and respiratory allergy, the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) organized the symposium "Shaping the Future of Respiratory Care" in April 2025 in Brussels, Belgium, at the occasion of the 10-year jubilee. Featuring keynote speakers from the World Health Organization and EUFOREA, this initiative had the following aims: (1) promoting dialogue on translating innovations into daily clinical practice; (2) encouraging collaboration between the different stakeholders in the respiratory field; and (3) defining strategic priorities to transform respiratory care and arrest the CRD epidemic over the next decade. The symposium highlighted the importance of moving toward predictive, preventive, and patient-centered medicine, while supporting value-based health care systems to improve long-term patient outcomes. This report summarizes the main insights and strategic directions discussed at the meeting.

BACKGROUND:The SYNAPSE phase 3 study demonstrated that mepolizumab significantly improves nasal polyp score (NPS), quality of life and symptom severity in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE:We aimed to evaluate mepolizumab effectiveness in a real-world cohort from 12 tertiary centers in 6 European countries. METHODOLOGY:A retrospective analysis was conducted in 110 CRSwNP patients (comorbid asthma: 86.4%). CRS-related outcomes were analyzed at baseline, 24 and 52 weeks of mepolizumab. Treatment response was evaluated based on EUFOREA 2021 criteria. RESULTS:Significant improvements in NPS, Sinonasal Outcome Test-22 (SNOT-22), and visual analog scale (VAS) symptom scores were observed at 24 and 52 weeks compared to baseline. Further improvement between weeks 24 and 52 was observed for NPS and SNOT-22. Asthma Control Test (ACT) also improved significantly by week 24 (ACT score ≥ 20: 64.5%). At least one response criterion (change in SNOT-22 ≥ 8.9, NPS ≥ 1, VAS total sinus symptoms ≥ 20, VAS nasal blockage ≥ 20, VAS loss of smell ≥ 20) was met by 85.6% and 78.7% of patients at 24 and 52 weeks, respectively. A more stringent composite response (SNOT-22 < 30, NPS < 4, VAS total sinus symptoms < 50, and VAS nasal blockage < 50) was achieved in 18.3% and 44.6% of patients at 24 and 52 weeks, respectively. CONCLUSION:Mepolizumab demonstrated clinically meaningful benefits in a real-world CRSwNP population, with nearly half of patients achieving a beneficial composite treatment response by week 52. Notably, progressive improvements between weeks 24 and 52 underscore the value of prolonged therapy and the importance of evaluating treatment response at one year.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an upper airways disease predominantly characterized by type 2 (T2) inflammation, leading to reduced quality of life and patient/healthcare burden. Many patients remain underdiagnosed for T2 inflammation in clinical practice as it is not often defined/considered, resulting in inadequate disease management. This research aimed to develop and evaluate a patient management plan (PMP) to be used by healthcare professionals (HCPs) in clinical practice to improve the management and standardization of management of patients with CRSwNP in Europe. A working group of six otorhinolaryngology (ORL) specialists and one patient advocacy group (PAG) representative, who form part of the European CRSwNP Alliance, developed the PMP. Two online surveys were disseminated to ORLs/PAGs and national CRSwNP Alliance members in December 2024 and January 2025, respectively, to evaluate the design and potential utility of the PMP in clinical practice across Europe. Survey 1 respondents agreed that key themes in the initial PMP (patient symptoms, management of comorbidities, agreed treatment goals, follow-up management) were likely to be effective in improving patient management. Respondents across both surveys suggested that the PMP would improve shared decision-making, follow-up, adherence, and increase understanding of CRSwNP as a chronic inflammatory condition. They agreed that the PMP could standardize the management of CRSwNP across Europe. The PMP could support patient–HCP education and communication, supplement management guidance, enhance shared decision-making, and ensure a timely, personalized, long-term treatment and management approach, including follow-up, for patients with CRSwNP.

AbstractBackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) is a recurrent inflammatory disease associated with several comorbidities and a significant disease burden for patients. Treatments include corticosteroids and sinonasal surgery, but these can be associated with the risk of adverse events and nasal polyp recurrence. Biologic treatments such as mepolizumab can be used as an add‐on treatment and are effective at reducing surgery and corticosteroid use.Main textPatients with CRSwNP may be seen by a specialist in one of several different areas and often experience delayed diagnosis due to the need to see multiple physicians, as well as misdiagnosis resulting from lack of sufficient expertise within any one speciality. Multidisciplinary team (MDT) approaches have been shown to be effective in optimising the treatment and clinical management of other respiratory diseases, such as aspirin‐exacerbated respiratory disease and severe asthma. In CRSwNP, an MDT approach may reduce diagnostic delays, mitigate secondary disease burden, and reduce overprescription of corticosteroids and antibiotics.ConclusionThis article provides an overview of the patient perspective of MDTs, existing approaches and barriers to adoption, lessons learnt from allied and rare diseases, how to address under‐recognised aspects of CRSwNP, and other key considerations for developing an MDT approach.

BACKGROUND:Chronic rhinosinusitis with nasal polyps (CRSwNP) is predominantly driven by type 2 inflammation. The biologics dupilumab and omalizumab, which target drivers and mediators of type 2 inflammation (interleukin [IL]-4/IL-13 signaling and immunoglobulin E [IgE], respectively), are efficacious in treating CRSwNP but direct comparisons are few. In EVEREST (EValuating trEatment RESponses of dupilumab versus omalizumab), the first head-to-head trial in respiratory biologics, we aimed to compare the efficacy and safety of dupilumab and omalizumab in patients with severe CRSwNP who had mild, moderate, or severe asthma. METHODS:EVEREST was an international, randomised, double-blind, phase 4 trial, conducted at 100 hospitals or clinical centres in 17 countries. Sites were selected with otolaryngology, pneumologist, allergist, and immunologist practices; needed to have previously conducted double-blind studies; and were required have nasal endoscopy and electrocardiogram machines. Eligible patients aged 18 years or older with severe uncontrolled CRSwNP (with a nasal polyp score of 5 or more [and ≥2 for each nostril]), symptoms of nasal congestion and loss of smell for at least 8 weeks before screening, and physician-diagnosed asthma. Patients were randomly assigned (1:1) to subcutaneous dupilumab 300 mg every 2 weeks or omalizumab weight-tiered and IgE-tiered dosing every 2 weeks or 4 weeks for 24 weeks, with background mometasone furoate nasal spray. Patients and investigators were masked to the study drugs. Primary endpoints were change from baseline in endoscopic nasal polyp score and University of Pennsylvania Smell Identification Test (UPSIT) at 24 weeks. Efficacy was assessed in the intention-to-treat population and safety was assessed in patients who received at least one dose of study medication. The trial was registered at ClinicalTrials.gov, NCT04998604. FINDINGS:Between Sept 27, 2021, and Dec 27, 2024, 819 individuals were screened for study inclusion, 459 were excluded (most common screen failures were: 167 did not meet nasal polyp score ≥5 or did not have ongoing symptoms of nasal congestion and loss of smell, 114 did not meet pre-bronchodilator FEV1 ≤85% predicted normal, and 99 did not meet eligibility as per omalizumab drug-dosing), and 360 participants were randomly assigned (181 assigned to the dupilumab group and 179 assigned to the omalizumab group). Of the 360 participants, 198 (55%) participants were male, 162 (45%) were female, and the mean age of the total population sample was 52 years (SD 13·1). Improvements were significantly greater with dupilumab than omalizumab for all primary and secondary efficacy endpoints at week 24. Least squares mean differences in change from baseline dupilumab over omalizumab were: nasal polyp score -1·60 (95% CI -1·96 to -1·25; p<0·0001) and UPSIT 8·0 (6·3 to 9·7; p<0·0001). 115 (64%) of 179 participants in the dupilumab group and 116 (67%) of 173 participants in the omalizumab group reported treatment-emergent adverse events, the most common of which were nasopharyngitis, accidental overdose, headache, upper respiratory tract infection, and cough. There were no deaths in the study. INTERPRETATION:Dupilumab was superior to omalizumab in patients with severe CRSwNP and coexisting asthma. These findings support the efficacy of dupilumab in patients with type 2 respiratory diseases versus an active biologic comparator, the known safety profiles of dupilumab and omalizumab, and could enable better treatment targeting for patients with CRSwNP and asthma in clinical practice. FUNDING:Sanofi and Regeneron Pharmaceuticals.

Background: In the phase III SYNAPSE study, mepolizumab plus standard of care reduced total endoscopic nasal polyp score (NPS) versus that with placebo in patients with chronic rhinosinusitis with nasal polyps. Objective: Our aim was to investigate relationships between NPS and (1) peak nasal inspiratory flow (PNIF) and (2) patient-reported outcomes. Methods: In this post hoc analysis, patients randomized 1:1 received mepolizumab, 100 mg, or placebo subcutaneously every 4 weeks (plus standard of care). Changes from baseline in PNIF (week 52), visual analog scale scores (overall symptoms, nasal obstruction, and loss of smell [weeks 49-52]), and total 22-Item Sino-Nasal Outcome Test score (week 52) were assessed in patients with or without improvements in NPS (improvement of >= 1 point) or without (improvement of <1 point or worsening). Results: Patients with improvements in NPS had greater improvements in PNIF (a median of 50 L per minute [interquartile range (IQR) = 10.5-87.5] with mepolizumab vs a median of 40 L per minute [IQR = 0-85.0] with placebo) than did those patients without improvements in NPS (a median of 0.0 L per minute [IQR = -10.0 to 45.0] with mepolizumab vs a median of 0.0 L per minute [IQR = -30.0 to 30.0] with placebo). Similar results were seen for the following: change from baseline in overall symptoms (a median of -5.8 [IQR = -8.1 to -3.80] with mepolizumab and a median of -4.1 [IQR = -7.0 to -1.2] with placebo with improvement in NPS vs a median of -1.3 [IQR = -6.3 to 0.0] with mepolizumab and a median of -0.1 [IQR = -3.4 to 0.0] with placebo without improvement in NPS); change in nasal obstruction (a median of -5.7 [IQR = -8.2 to -3.5] with mepolizumab and a median of -4.5 [IQR = -7.3 to -1.2] with placebo with improvement in NPS vs a median of -1.3 [IQR = -6.6 to 0.0] with mepolizumab and a median of 0.0 [IQR = -3.6 to 0.0] with placebo without improvement in NPS); change in loss of smell (a median of -2.8 [IQR = -7.9 to 0.0] with mepolizumab and a median of -0.7 [IQR = -4.0 to 0.0] with placebo with improvement in NPS vs a median of 0.0 [IQR = -2.4 to 0.0] with mepolizumab and a median of 0.0 [IQR = -0.3 to 0.0]) with placebo without improvement in NPS); and change in visual analog scale score and 22-Item Sino-Nasal Outcome Test total score (a median of -37.0 [IQR = -52.0 to -24.0] with mepolizumab and a median of -29.0 [IQR = -43.0 to -9.0] with placebo with improvement in NPS vs a median of -16.0 [IQR = -42.0 to 0.0] with mepolizumab and a median of 0.0 [IQR = -27.0 to 0.0] with placebo without improvement in NPS). Conclusion: Improvement in NPS was associated with improvements in PNIF and patient-reported outcomes irrespective of treatment. PNIF could be a useful noninvasive tool for monitoring nasal polyp size.

OBJECTIVES To investigate if there is still a place for bioprosthetic mitral valve replacement in children by comparing the prosthetic durability and transplant-free survival after bioprosthetic and mechanical mitral valve replacement. METHODS We reviewed all mitral valve replacements in children between 1981 and 2020. Bioprosthetic mitral valve replacement cases were individually matched to mechanical mitral valve replacement cases. The incidence rate of a 2nd replacement was calculated using the cumulative incidence function that considered death or transplantation as a competing risk. RESULTS The median age at implantation was 3.6 years (interquartile range 0.8-7.9) for the bioprosthetic valve cohort (n = 28) and 3 years (interquartile range 1.3-7.8) for the mechanical valve cohort (n = 28). Seven years after bioprosthetic mitral valve replacement, the cumulative incidence of death or transplantation was 17.9% [95% confidence interval (CI) 6.3-34.1] and the cumulative incidence of a 2nd replacement was 63.6% (95% CI 39.9-80.1). Seven years after mechanical mitral valve replacement, the cumulative incidence of death or transplantation was 28.6% (95% CI 13.3-46) and the cumulative incidence of a 2nd replacement was 10.7% (95% CI 2.6-25.5). Fifteen years after mechanical mitral valve replacement, the cumulative incidence of death or transplantation was 33.6% (95% CI 16.2-52.1) and the cumulative incidence of a 2nd replacement was 41.1% (95% CI 18.4-62.7). The cumulative incidence curves for bioprosthetic and mechanical mitral valve replacement were statistically different for a 2nd valve replacement (P < 0.001) but not for death or transplantation (P = 0.33). CONCLUSIONS There is no difference in transplant-free survival after bioprosthetic and mechanical mitral valve replacement in children. The lifespan of bioprosthetic mitral valves remains limited in children because of structural valve failure due to calcification. After 15 years, 40% of mechanical valves were replaced, primarily because of patient-prosthesis mismatch related to somatic growth.

Background Allergic rhinitis (AR) is a common condition that is frequently associated with atopic inferior turbinate hypertrophy (ITH) resulting in nasal obstruction. Current guidelines support the use of subcutaneous allergen immunotherapy (SCIT) when patients fail pharmacologic management. However, there is a lack of consensus regarding the role of inferior turbinate reduction (ITR), a treatment that we hypothesize is cost‐effective compared with other available treatments. Methods We conducted a cost‐effectiveness analysis comparing the following treatment combinations over a 5‐year time horizon for AR patients presenting with atopic nasal obstruction who fail initial pharmacotherapy: (1) continued pharmacotherapy alone, (2) allergy testing and SCIT, (3) allergy testing and SCIT and then ITR for SCIT nonresponders, and (4) ITR and then allergy testing and SCIT for ITR nonresponders. Results were reported as incremental cost‐effectiveness ratios (ICERs). Results For patients who fail initial pharmacotherapy, prioritizing ITR, either by microdebrider‐assisting submucous resection or radiofrequency ablation, before SCIT was the most cost‐effective strategy. Probabilistic sensitivity analysis demonstrated that prioritizing ITR before SCIT was the most cost‐effective option in 95.4% of scenarios. ITR remained cost‐effective even with the addition of concurrent septoplasty. Conclusion For many AR patients who present with nasal obstruction secondary to atopic inferior turbinate hypertrophy that is persistent despite pharmacotherapy, ITR is a cost‐effective treatment that should be considered prior to immunotherapy. Level of Evidence NA – Laryngoscope, 2023 Laryngoscope , 134:1572–1580, 2024

•EUFOREA asthma pocket guide is an educational and practical tool for non-respiratory physicians, paramedics and patients.•EUFOREA asthma pocket guide provides a simplified algorithm on asthma diagnosis, treatment and specialist referral.•EUFOREA asthma pocket guide is a living document which can be accessed at www.euforea.eu/news/asthma-pocket-guide.

Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) is a clinical syndrome characterized by nasal polyposis, asthma, and intolerance to aspirin/NSAID. It affects approximately 15% cases of severe asthma, 10% of nasal polyps and 9% of rhinosinusitis. N-ERD results in associated asthma exacerbations, oral corticosteroids bursts, corticosteroid-dependent disease, and multiple endoscopic sinus surgeries. Unknown influences cause polyp epithelium to release alarmins, such as IL-33 and TSLP. These cytokines activate lymphoid cells, both Th2 and ILC2, to release cytokines such as IL5, IL4 and IL13, resulting in complex type 2 inflammation involving mast cells, eosinophils and platelets. Arachidonic acid released from such cells is metabolized into mediators. N-ERD is characterized by an imbalance in eicosanoid levels, especially CysLTs, PDG and PGE2. Patients with N-ERD present nasal symptoms (congestion, hyposmia/anosmia, nasal discharge) and lower airways symptoms (cough, sneezing, shortness of breath, chest tightness), anosmia, severe hyposmia as well as severe asthma which impacts the quality of life in this disease and leads to safety concerns in patients daily lives. Despite the variety of treatment strategies, the likelihood of recurrence of symptoms is high in patients with N-ERD. The most important strategies for treating N-ERD are listed as following: drug therapies, aspirin desensitization, monoclonal antibodies and other therapies associated. N-ERD treatment remains a major challenge in the current situation. Selecting the appropriate patient for aspirin desensitization, monoclonal antibodies or both is essential. This review provides an overview on aspirin desensitization and biologics in N-ERD and might help in decision making from both the perspective of the physician and patient. Patient characteristics, safety, efficacy, health care costs, but also patient preferences are all factors to take into account when it comes to a choice between biologics or aspirin desensitization.

With no consensus document or guideline to help us compute the psychological make-up of rhinoplasty candidates and in the light of new perspectives of some key opinion leaders in the field of patient selection, the goals of this article are to offer a glimpse of the current literature together with the knowledge gaps, introduce some new tools for the preoperative consultation, help us identify who among our patients is at greatest risk for a poor outcome, and explain how childhood trauma can be linked to body shame and postoperative dissatisfaction.

Abstract Background The aetiology of chronic rhinosinusitis (CRS) is multifactorial with a complex interplay between environmental, microbial endogenous and genetic factors. The impact of outdoor air pollution on prevalence or severity of CRS remains largely unknown. Methods Real-life geolocation data (2017–2018, Belgium) from 278 CRS patients (2576 health records) using the mySinusitisCoach mobile application were analysed to calculate the patients’ individual exposure to outdoor air pollutants (ozone (O3), black carbon (BC), nitrogen dioxide (NO2) and particulate matter with diameter < 2.5 μm (PM2.5)) and to associate these pollutants with the patients’ sinus related symptoms measured at multiple occasions by visual analogue scale (VAS). Results The adjusted seasonal model for the spring–summer (n = 1000 health entries, N = 83 patients) population revealed an increase of 6.07 (p < 0.0001) in overall CRS symptom scoring for an interquartile range (IQR) increase in exposure to O3 (26.9 μg/m3). An increase of 1.69 (p = 0.05) in total CRS symptom scoring was observed for an IQR increase of PM2.5 (7.1 µg/m3) exposure. Sex-stratified analysis in the spring–summer population showed significant interaction between air pollution and sex with male patients having higher total CRS symptom scores for an IQR increase in exposure to PM2.5 (3.52, p = 0.001), and O3 (8.33, p < 0.0001), while no significant association with symptom severity was seen in the female patients. In the analysis stratified by comorbid asthma, CRS patients with comorbid asthma had higher total CRS symptoms for an IQR increase in exposure to PM2.5 (2.58, p = 0.04) and O3 (7.72, p < 0.0001) while the patients without comorbid asthma had no significant symptom increases. Conclusion Exposure to outdoor air pollution is associated with increased symptom severity in CRS patients. The extent to which CRS patients are sensitive to outdoor air pollution exposure varies per season and depends on their sex and comorbid asthma status. mHealth technology has the potential to reveal novel insights on the patients’ exposome and disease severity in the real-life situation.

Rhinoplasty is uniquely suited to capitalize on different aspects of three-dimensional (3D) modeling technology. Currently, 3D surface imaging of preoperative and postoperative nasal structure provides a platform for better surgical planning and patient counselling as well as objective postoperative measurements. Physical nasal models using 3D printing technology can improve rhinoplasty performance intraoperatively, postoperative outcomes, together with nasal prosthetic manufacture, by tailoring to specific patient anatomy. Advances in tissue engineering using 3D-printed biocompatible scaffolds have shown excellent nasal cartilage mimicry and hold promise for increasingly versatile directed tissue regeneration in rhinoplasty and nasal reconstructive surgery. As health care innovations are expected to become increasingly common in standard rhinoplasty practices in the future, we give an account of how 3D technologies can create new opportunities to optimize surgical planning and improve overall the patient experience.

Adequate nasal breathing is indispensable for athletes, and nasal symptoms have been shown to interfere with their subjective feeling of comfortable breathing and quality of life. Nasal symptoms are caused by either structural abnormalities or mucosal pathology. Structural pathologies are managed differently from mucosal disease, and therefore, adequate diagnosis is of utmost importance in athletes in order to choose the correct treatment option for the individual. Literature suggests that nasal symptoms are more prevalent in athletes compared to the general population and certain sports environments might even trigger the development of symptoms. Given the high demands of respiratory function in athletes, insight into triggering factors is of high importance for disease prevention. Also, it has been suggested that athletes are more neglectful to their symptoms and hence remain undertreated, meaning that special attention should be paid to education of athletes and their caregivers. This review aims at giving an overview of nasal physiology in exercise as well as the possible types of nasal pathology. Additionally, diagnostic and treatment options are discussed and we focus on unmet needs for the management and prevention of these symptoms in athletes within the concept of precision medicine.