Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by persistent sinonasal inflammation and sinus microbiome dysbiosis. Nasal polyps (NPs) is one of the main manifestations which cause diverse clinical symptoms of CRS. We conducted a bibliometric and visual analysis of CRS and NPs articles published between 2003 and 2022 to provide researchers with the current state of research and potential directions. Method: We used a systematic search strategy to search relevant articles in the databases of the Web of Science from 2003 to 2022. VOSviewers, Bibliometrix R package, and CiteSpace were used to perform the bibliometric analysis. Results: 3,907 publications, including 3,266 “articles” and 641 “reviews” were retrieved. The USA made the highest contributions to global research, followed by China; furthermore, Northwestern University, Capital Medical University, and Sun Yat-Sen University had the highest number of publications. A total of 12,894 authors participated in this research, with the most published author being Bachert C., followed by Schleimer Robert P. and Schlosser Rodney J.. And the authors with the most co-citations were Bachert C., Fokkens W.J., and Gevaert P. 428 journals had published the articles of this research. Moreover, the journal with the most publications was the International Forum Of Allergy & Rhinology and the Journal Of Allergy And Clinical Immunology received the most citations. “Covid-19”, “biologic”, and “type 2 inflammation” were the top current research hotspots. Conclusion: The United States and Northwestern University were the leading country and institution in researching CRS and NPs. And Bachert C. is the most influential expert. The International Forum Of Allergy & Rhinology published the most articles, and the Journal Of Allergy And Clinical Immunology got the highest number of citations. Moreover, “Covid-19”, “biologic”, and “type 2 inflammation” were the trending topics.

Background: Whether the CD40-CD40 ligand (CD40L) and inducible co-stimulatory molecule (ICOS)-ICOS ligand (ICOSL) signals are involved in chronic rhinosinusitis (CRS) development needs further investigation. Objectives: To investigate the association of CD40-CD40L and ICOS-ICOSL expression with CRS and underlying mechanisms. Methods: Immunohistology detected the expression of CD40, CD40L, ICOS, and ICOSL. Immunofluorescence was performed to evaluate the co-locations of CD40 or ICOSL with eosinophils. Correlations between CD40-CD40L and ICOS-ICOSL as well as clinical parameters were analyzed. Flow cytometry was used to explore the activation of eosinophils by CD69 expression and the CD40 and ICOSL expression on eosinophils. Results: Compared with the Non-eCRS subset, ECRS (Eosinophilic chronic rhinosinusitis) subset showed significantly increased CD40, ICOS, and ICOSL expression. The CD40, CD40L, ICOS, and ICOSL expressions were all positively correlated with eosinophil infiltration in nasal tissues. CD40 and ICOSL were mainly expressed on eosinophils. ICOS expression was significantly correlated with the expression of CD40-CD40L, while ICOSL expression was correlated with CD40 expression. ICOS-ICOSL expression positively correlated with blood eosinophils count and disease severity. rhCD40L and rhICOS significantly enhanced the activation of eosinophils from ECRS patients. TNF-α and IL-5 obviously upregulated CD40 and ICOSL expression on eosinophils, which was significantly inhibited by the p38 MAPK inhibitor. Conclusions: Increased CD40-CD40L and ICOS-ICOSL expression in nasal polyps are linked to eosinophils infiltration and disease severity of CRS. CD40-CD40L and ICOS-ICOSL signals enhance eosinophils activation of ECRS. TNF-α and IL-5 regulate eosinophils function by increasing CD40 and ICOSL expression partly via p38 MAPK activation in CRS patients.