ABSTRACT
Recent evidence supports the view that chronic rhinosinusitis (CRS) with or without nasal polyps represents different disease entities, characterized by specific cytokine and mediator profiles. Nasal polyps in adults, characterized by abundant eosinophils, local overproduction of immunoglobulin E, and often associated with asthma, have been appreciated as an eosinophilic inflammation, potentially of allergic origin, but unrelated to a bacterial impact. Evidence accumulates, however, that Staphylococcus aureus colonizes CRS with polyps, but not without, with significantly increased prevalence. The bacteria release enterotoxins, which act as superantigens and induce a local multiclonal immunoglobulin (IgE) formation as well as a severe, possibly steroid-insensitive eosinophilic inflammation.
