The Sydney Rhinology Research Group’s approach to chronic rhinosinusitis starts with identifying the process driving disease. Professor Richard Harvey and colleagues study how clinical phenotype, inflammatory biology, surgical anatomy and treatment delivery interact. The aim is sustained disease control with an appropriate treatment burden.
This research theme explains the reasoning behind the group’s published work: classify the disease, understand the affected tissue, plan access for treatment and reassess the response over time.
Classify the disease before selecting treatment
A nasal polyp describes a finding. Its presence alone does not explain the underlying process. A review co-authored by Professor Harvey describes primary chronic rhinosinusitis by anatomical distribution, dominant inflammatory mechanism and clinical phenotype. An endotype describes the biological mechanism; a phenotype describes the observable pattern in the patient. [1]
This framework makes the origin of abnormal tissue, the history of allergy and asthma, and the distribution of disease relevant to treatment decisions. In practice, the question is which mechanism and tissue changes need to be addressed in this patient.
Diffuse eosinophilic disease: surgery that supports ongoing treatment
In diffuse eosinophilic chronic rhinosinusitis, the group’s published model treats the sinuses as an inflammatory airway surface. Surgery creates a broadly accessible neosinus cavity by removing partitions between sinus compartments, allowing topical treatment to reach the affected mucosa. Ongoing corticosteroid irrigation is integral to this approach. [2]
A prospective cohort of 222 patients reported that 87.8% met the study’s definition of well-controlled disease at a median follow-up of 2.2 years. These outcomes reflect an integrated strategy of sinus surgery followed by ongoing treatment of mucosal inflammation. [2]
Treatment delivery has also been tested directly. In a randomised trial of 44 postoperative patients, both mometasone spray and irrigation groups improved, with irrigation producing greater improvement in nasal blockage and selected imaging and endoscopic outcomes. [3]
CCAD: identify the allergic phenotype and address its driver
Central compartment atopic disease (CCAD) requires attention to the allergic history and the origin of tissue remodelling on endoscopy, particularly the middle or superior turbinates and upper posterior septum. The diagnosis brings together the allergic history and endoscopic findings, with CT providing supporting anatomical information. Professor Harvey’s discussion of the defining features of CCAD explains this distinction.
The treatment implication is to address both established structural change and the inhalant-allergy response. Surgery can improve the consequences of remodelling and access for topical medication. Allergen immunotherapy targets the allergic response in appropriately selected patients.
The group’s retrospective study of 86 surgically treated, house dust mite-sensitised CCAD patients found less recurrent middle turbinate oedema and lower topical corticosteroid requirements in the immunotherapy group at 12 months. Symptom scores were similar. These findings support addressing the allergic driver alongside surgical treatment of established tissue remodelling. [4]
Interpret allergy tests in the context of the nose
Skin and blood tests measure systemic sensitisation. They may not capture an allergic response concentrated within nasal tissue. The group’s research on local IgE and nasal sampling informs an approach in which history, endoscopy and testing are considered together. A negative systemic result can reduce the likelihood of allergy without automatically excluding it.
Professor Harvey describes this reasoning in when a negative allergy test does not rule out allergy.
Surgery and biologics within a combined strategy
The group’s 2026 observational study examined 159 patients receiving biologics for severe type 2 disease after previous sinus surgery. More extensive frontal sinus surgery was associated with better composite disease control. [5]
The practical implication is to assess the healed surgical cavity and delivery of topical treatment alongside the response to a biologic. Surgical planning, topical therapy and biologic selection are considered together in the pursuit of disease control.
Measure disease control across symptoms, examination and treatment burden
The same study assessed control using symptoms, endoscopic inflammation and freedom from rescue treatment. This reflects the group’s interest in stable clinical benefit: improved symptoms, controlled mucosal inflammation and reduced need for rescue treatment. [5]
Follow-up brings these measures together with the patient’s disease phenotype and treatment history to assess progress and guide ongoing care.
Research, teaching and collaboration
These themes connect the group’s published investigations with Professor Harvey’s teaching on disease classification, allergy treatment and integrated medical and surgical care. Learn more about Professor Richard Harvey’s research and academic leadership, explore the research and publications program, or contact the group about collaboration.
Surgeons can find details of the Sydney observer program and one-year clinical fellowship. Patients can visit Professor Richard Harvey’s clinical website for information about assessment and care.
Selected research
1. Grayson JW, Hopkins C, Mori E, Senior B, Harvey RJ. Contemporary classification of chronic rhinosinusitis beyond polyps vs no polyps: a review. JAMA Otolaryngol Head Neck Surg. 2020;146(9):831–838. doi:10.1001/jamaoto.2020.1453.
2. Li W, Ho J, Grayson JW, et al. Evaluation of diffuse type 2 dominant or eosinophilic chronic rhinosinusitis…after surgical neosinus cavity formation. JAMA Otolaryngol Head Neck Surg. 2021;147(4):360–367. doi:10.1001/jamaoto.2020.5286.
3. Harvey RJ, Snidvongs K, Kalish LH, Oakley GM, Sacks R. Corticosteroid nasal irrigations…in a randomised trial for chronic rhinosinusitis after sinus surgery. Int Forum Allergy Rhinol. 2018;8(4):461–470. doi:10.1002/alr.22093.
4. Meerwein CM, Sacks PL, Ho J, et al. The effect of allergen immunotherapy in patients with central compartment atopic disease post-surgery. Int Forum Allergy Rhinol. 2025;15(2):128–134. doi:10.1002/alr.23459.
5. Campion NJ, Sacks PL, Png LH, et al. Extent of sinus surgery is associated with disease control in biologic treated type 2 dominant CRS. Int Forum Allergy Rhinol. Published online 10 April 2026. doi:10.1002/alr.70166.