International Rhinologic Society Rhinology 0300-0729 2026 10 10 Surgery and/or biologics in chronic rhinosinusitis with nasal polyps: EUFOREA/EPOS consensus paper EN E. de Corso University of Perugia, Department of Medicine and Surgery, Section of Otorhinolaryngology, Santa Maria della Misericordia Hospital, Perugia, Italy P.W. HellingsLaboratory of Upper Airways Research, Department of Otorhinolaryngology, University of Ghent, Ghent, Belgium Allergy and Clinical Immunology Research Unit, KU Leuven Department of Microbiology and Immunology, Leuven, Belgium Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium W.J. Fokkens Amsterdam UMC, University of Amsterdam, Department of Otorhinolarynogology, Amsterdam, the Netherlands C. Hopkins Department of Rhinology and Skull Base Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK V.J. Lund University College London, UK and Honorary ENT Surgeon, Royal National Ear, Nose, Throat and Eastman Dental Hospi-tal, UCLH, London, UK C. Montuori Department of Head, Neck and Sensory Organs, Catholic University of Sacred Heart, Rome, Italy J. Mullol Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic Barcelona, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain X. BertelsScientific Expert Team Members, The European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands V. Backer Department of Rhinolaryngology, Head and Neck surgery, and Audiology, Rigshospitalet, Copenhagen University hospital, Copenhagen, Denmark E. Pasquini Department of Otolaryngology, Head and Neck Surgery, Bellaria Hospital, AUSL Bologna, Bologna, Italy B.S. Bleier Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA C. PipoloDepartment of Otorhinolaryngology, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy Department of Health Sciences, Università degli Studi di Milano, Milan, Italy M. Wagenmann Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Dusseldorf, Germany M. Bernal-Sprekelsen Hospital Clinic, Barcelona, University of Barcelona, Spain M. Cornet Alrijne Ziekenhuis, Leiderdorp, the Netherlands D.M. ContiAllergy and Clinical Immunology Research Unit, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium Escuela de Doctorado UAM, Centro de Estudios de Posgrado, Universidad Autónoma de Madrid. Calle Francisco Tomás y Valiente, nº 2. Ciudad Universitaria de Cantoblanco, Madrid, Spain P. Gevaert Upper Airways research Laboratory, Department of Head and Skin, University of Ghent, Ghent, Belgium R. Harvey Rhinology Research Unit, Royal National Throat Nose and Ear Hospital, London, United Kingdom J.K. Han Department of Otolaryngology, Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA L. Klimek Center for Rhinology and Allergology, Wiesbaden, Germany R.C. Kern Department of Otolaryngology, Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA B.N. Landis Rhinology-Olfactology Unit, Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Geneva, Geneva, Switzerland S. Lee Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Mass General Brigham, Boston, MA I. Alobid Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIBERES, Universitat de Barcelona, Spain A.U. LuongDepartment of Otorhinolaryngology, Head and Neck Surgery, University of Texas Health Science Center, Houston, TX, USA Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School at The University of Texas Health Science Center, Houston, TX, USA S. Reitsma Amsterdam UMC, University of Amsterdam, Department of Otorhinolarynogology, Amsterdam, the Netherlands S. Schneider Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria G.K. ScaddingDepartment of Allergy and Rhinology, Royal National ENT Hospital, London, United Kingdom Division of Immunity and Infection, University College, London, United Kingdom A.R. Sedaghat Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA B. Senior Department of Otolaryngology, Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA A.V. Thamboo Division of Otolaryngology, Head and Neck Surgery, University of British Columbia, Vancouver, Canada K.C. Welch Department of Otolaryngology, Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Y. Chan Department of Otolaryngology, Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada J. Constantinidis Department of Otorhinolaryngology, Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece A. Bader Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, Medina, Saudi Arabia N.H. AlOtaibi Department of Otolaryngology, Head S. Alsaleh Security Forces Hospitals Program, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia M. Al-Ahmad Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait A.T. Peters Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States Journal Article 3639 10.4193/Rhin26.064 The therapeutic landscape of chronic rhinosinusitis with nasal polyps (CRSwNP) has rapidly evolved over the past 6 years with the arrival of biologics, prompting a re-evaluation of the traditional stepwise management centred on corticosteroids and endoscopic sinus surgery (ESS). Although both ESS and biologics have proven efficacy, the optimal sequence, extent and timing of ESS relative to biologics remains a matter of debate. The international multidisciplinary panel of experts of EUFOREA/EPOS reached consensus on the aims, indications, timing, and therapeutic positioning of ESS, and biologics in CRSwNP. Evidence from pivotal RCTs, real-life studies and recent guidelines was critically reviewed. Consensus statements were drafted and refined through multiple rounds of discussion and voting. This EUFOREA/EPOS report provides key definitions and clinical criteria for ESS and biologics particiin CRSwNP, offering a unified framework for personalized, evidence-based care with the aim to achieve the best outcomes for patients. The expert group agreed that patients with diffuse disease should have at least a primary complete ESS, that concurrent initiation of sinus surgery and biologic therapy is not recommended with current evidence, and the indication for biologic therapy as established by earlier guidelines were enforced. It was emphasized that with the current knowledge on side effects of systemic corticosteroids, their long-term use is no longer accepted especially where biologics are available. By emphasizing complementary and disease-modifying effects of novel care strategies, this initiative aims at optimizing outcomes across the entire airway continuum in line with EPOS/EUFOREA's mission.