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longer display an invasive ability on HNECs. This study has important clinical consequences, as these antibiotics might decrease inflammation associated with S. aureus biofilm exoproteins. Understanding the CRS pathophysiology may offer better diagnostic techniques and permit the development of new treatment strategies. The contribution of nitric oxide (NO) in CRS is discussed in the current literature [12,13,14]. Vlad et al. [15] assessed the arginase (ARG) expression in the mucosa of CRS patients. Increased ARG concentration can decrease NO levels by lessening the accessibility of its precursor, L-arginine. CRS patients expressed significantly higher ARG2 levels as compared to controls. ARG2 levels were significantly increased in CRS without polyps, while in polyposis, ARG2 levels did not reach statistical significance despite showing an increase. CRS without allergy displayed significantly increased levels of ARG2. Compared to controls, ARG2 levels were also significantly increased in non-asthmatic CRS patients and in non-allergic, non-asthmatic CRS patients. In the univariate analysis of CRS patients using the comparisons of allergic vs. non-allergic, asthmatic vs. non-asthmatic, non-asthmatic allergic vs. non-asthmatic non-allergic, and non-allergic asthmatic vs. non-allergic-non-asthmatic, ARG2 levels were statistically higher in non-allergic CRS patients and non-allergic and non-asthmatic patients. The authors suggest that an improved knowledge of ARG functions in CRS will allow the development of personalized treatments. Kim et al. [16] assessed in their study trends in micro-organisms isolated form CRS patients from Korea, undergoing endoscopic sinus surgery (ESS) in the following periods: 2007–2008, 2011–2012, and 2017–2018. During this time period, the authors undertook endoscopically guided bacterial cultures from the sinus. A total of 510 adult patients were retrospectively reviewed. The bacteria recovery rate was 73.9% for polyposis and 82.8% for CRS without polyps. The analysis demonstrated a significant increase over time in the presence of coagulase negative Staphylococci (CNS), Klebsiella and Pseudomonas aeruginosa. The authors emphasized the significant increasing trend of Gram-negative bacteria isolation in CRS patients. Moreover, extended-spectrum beta-lactamase (ESBL) Klebsiella and Enterobacter displayed an increasing trend over time. The authors underline the importance of current recommendations of endoscopically guided cultures during ESS. Thus, pathogenic bacteria should be isolated and targeted antibiotics should be prescribed. Fungal rhinosinusitis is a unique type of CRS with special clinical and pathologic features. In their paper, Lu et al. [17] explore the contribution of bacterial microbiota in different types of CRS. It is well known that conventional culture techniques provide limited evidence regarding bacterial pathogens. On the contrary, next-generation sequencing (NGS), a culture-independent technique, provides a superior illustration of microbiota. The authors undertook 16S rRNA amplification sequencing to discover differences between fungal and non-fungal CRS and between the middle meatus and the nasopharynx. The authors enrolled 7 consecutive fungal and 18 consecutive non-fungal CRS patients in the study. Extracted DNA was analyzed through 16S rRNA amplification. The authors demonstrate that bacterial community diversity was significantly lower in the middle meatus of fungal CRS. Nevertheless, no significant differences were observed between the diversity samples collected from the nasopharynx. Corynebacterium and Fusobacterium were detected in only non-fungal CRS patients. On the contrary, Haemophilus and Pseudomonas were both highly prevalent and abundant in fungal CRS. This feature could be associated with bacterial–fungal interaction. The study emphasized that bacterial
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