Management of Chronic Rhinosinusitis with Nasal Polyps
Summary
Chronic rhinosinusitis with nasal polyps is an inflammatory disorder of the nasal and paranasal sinus mucosa characterised by persistent mucosal oedema, polyp formation and variable airway obstruction. Management begins with accurate phenotyping and endotyping to distinguish type 2 dominant disease, marked by eosinophilic inflammation and elevated interleukin-5 and interleukin-13, from non-type 2 variants. First-line therapy typically comprises intranasal corticosteroids and saline irrigation, aimed at reducing mucosal swelling and improving sinonasal drainage. Systemic corticosteroids serve as short-term rescue therapy in severe exacerbations but carry risks of systemic side effects. Endoscopic sinus surgery is indicated for patients refractory to medical therapy and seeks to restore sinus ventilation and facilitate drug delivery. In recent years, targeted biologic agents directed against key cytokines have transformed the treatment landscape, offering long-term polyp reduction and quality-of-life improvement in patients with type 2 endotype. Therapeutic decision-making now emphasises a multimodal, personalised approach that integrates medical, surgical and biological modalities to achieve sustained disease control.
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Management of Chronic Rhinosinusitis with Nasal Polyps publication trend
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Technical terms
Chronic rhinosinusitis with nasal polyps (CRSwNP): A persistent inflammatory condition of the sinuses and nose accompanied by benign mucosal outgrowths.
Functional endoscopic sinus surgery (FESS): A minimally invasive surgical technique to restore sinus ventilation and drainage.
Type 2 inflammation: An immune response characterised by eosinophils and cytokines such as interleukin-4, interleukin-5 and interleukin-13.
Endotype: A subtype of disease defined by a distinct pathophysiological mechanism or biomarker profile.
Biologic therapy: Treatment using monoclonal antibodies or receptor antagonists that specifically target inflammatory mediators.
Exhalation delivery system (EDS): A mechanism that uses patient exhalation to propel medication deeper into the sinonasal cavities.
References
- Effect of postoperative systemic prednisolone on short-term and long-term outcomes in chronic rhinosinusitis with nasal polyps: A multi-centered randomized clinical trial. Frontiers in Immunology (2023).
- Efficacy of EDS-FLU for Chronic Rhinosinusitis: Two Randomized Controlled Trials (ReOpen1 and ReOpen2). The Journal of Allergy and Clinical Immunology In Practice (2024).
- Perspectives in Therapy of Chronic Rhinosinusitis. Diagnostics (2022).
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