Stratification of chronic rhinosinusitis with nasal polyps by distinct sinonasal microbial communities and their clinical and pathological correlations

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory condition. Dysbiosis is commonly observed. This study identified distinct sinonasal microbial communities in CRSwNP patients and explored their clinical and pathological associations. Two distinct microbial communities were identified: community type 1 (CT1), dominated by Corynebacterium, Propionibacterium, and Peptoniphilus; and community type 2 (CT2), dominated by Streptococcus, Porphyromonas, and Bacteroides. CT1 exhibited significantly reduced microbial diversity and was enriched in pro-inflammatory pathways, whereas CT2 showed higher microbial diversity, with pathways supporting anti-inflammatory. Clinically, CT1 patients demonstrated higher disease severity and increased eosinophil infiltration, compared with CT2. CRSwNP patients can be stratified into two distinct microbial communities, each with specific clinical and pathological profiles. Microbial-based stratification may inform tailored therapeutic strategies to address the diverse clinical and pathological manifestations of CRSwNP.