International Rhinologic Society Rhinology 0300-0729 2026 06 04 Endoscopic sinus surgery versus biologic therapy for chronic rhinosinusitis with nasal polyposis: a systematic review with meta-analysis EN H. Majeethia Department of Otolaryngology – Head and Neck Surgery, Houston Methodist Hospital, Houston, TX, USA Z. Mehdi Department of Otolaryngology – Head and Neck Surgery, Houston Methodist Hospital, Houston, TX, USA O.G. Ahmed Department of Otolaryngology – Head and Neck Surgery, Houston Methodist Hospital, Houston, TX, USA M. Takashima Department of Otolaryngology – Head and Neck Surgery, Houston Methodist Hospital, Houston, TX, USA G.A. Kelley School of Public and Population Health and Department of Kinesiology, Boise State University, Boise, ID, USA J. Lee Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA H.H. Ramadan Department of Otolaryngology – Head and Neck Surgery, West Virginia University, Morgantown, WV, USA C.A. Makary Department of Otolaryngology – Head and Neck Surgery, West Virginia University, Morgantown, WV, USA Journal Article 3412 10.4193/Rhin25.345 Biologic therapies targeting type 2 inflammation, such as dupilumab, omalizumab, and mepolizumab, have been developed to manage chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in patients with comorbid asthma or aspirin-exacerbated respiratory disease (AERD). Functional endoscopic sinus surgery (FESS) remains the mainstay of treatment in patients who are refractory to medical therapy. However, direct comparisons between biologic therapy and FESS are limited. This systematic review and meta-analysis aimed to compare sinonasal outcomes between FESS and biologic therapy in real-world settings.