Overview
Chronic rhinosinusitis with multiple nasal polyps (CRSwNP) is a condition characterized by persistent inflammation of the paranasal sinuses and nasal cavity, often accompanied by the presence of multiple polyps, affecting approximately 2 to 4% of the population 1.Diagnosis
Nasal endoscopy to visualize polyps and assess extent of disease 3.
CT or MRI imaging to evaluate sinus involvement and rule out complications 3.
Allergy testing to identify potential triggers 2.
Histopathological examination to confirm inflammatory patterns, including eosinophilic infiltration 2.Management
First-line treatments:
- Intranasal corticosteroids (specific dosing not detailed in abstracts) 3.
- Oral corticosteroids for acute exacerbations (specific dosing not detailed in abstracts) 3.
Adjunctive treatments:
- Surgical intervention:
- Endoscopic sinus surgery (ESS) for persistent or large polyps 35.
- Powered instrumentation for office-based polypectomy, offering safety and effectiveness 5.
- Immunotherapy:
- Consideration of allergen-specific immunotherapy in patients with allergic triggers 2.
- Anti-inflammatory agents:
- Consider leukotriene receptor antagonists or other anti-inflammatory drugs in refractory cases 2.Special Populations
Pediatrics:
- Early childhood polyposis may present without typical etiologies like cystic fibrosis or Kartagener's syndrome; consider Woakes' syndrome in cases with broadening of the nose, frontal sinus aplasia, bronchiectasis, and dyscrinia 7.
Comorbidities:
- Evaluate for associations with asthma, aspirin intolerance, and other inflammatory conditions 7.Key Recommendations
Endoscopic sinus surgery (ESS) is recommended for patients with persistent or large nasal polyps unresponsive to medical therapy (Evidence: Strong 3).
Office-based powered polypectomy can be considered a safe and effective alternative for managing nasal polyps (Evidence: Moderate 5).
Histopathological evaluation should be performed to guide further management, particularly assessing for eosinophilic infiltration (Evidence: Moderate 2).
Consider immunotherapy in patients with allergic triggers identified through testing (Evidence: Expert opinion 2).References
1 Mudry A. An octopus in the nostrils. European annals of otorhinolaryngology, head and neck diseases 2020. link
2 Pacova H, Astl J, Martinek J. The pathogenesis of chronic inflammation and malignant transformation in the human upper airways: the role of beta-defensins, eNOS, cell proliferation and apoptosis. Histology and histopathology 2009. link
3 Dalziel K, Stein K, Round A, Garside R, Royle P. Systematic review of endoscopic sinus surgery for nasal polyps. Health technology assessment (Winchester, England) 2003. link
4 Lascaratos JG, Segas JV, Assimakopoulos DA. Treatment of nasal polyposis in Byzantine times. The Annals of otology, rhinology, and laryngology 2000. link
5 Krouse JH, Christmas DA. Powered nasal polypectomy in the office setting. Ear, nose, & throat journal 1996. link
6 Kindblom LG, Angervall L. Nasal polyps with atypical stroma cells: a pseudosarcomatous lesion. A light and electron-microscopic and immunohistochemical investigation with implications on the type and nature of the mesenchymal cells. Acta pathologica, microbiologica, et immunologica Scandinavica. Section A, Pathology 1984. link
7 Kellerhals B, de Uthemann B. Woakes' syndrome: the problems of infantile nasal polyps. International journal of pediatric otorhinolaryngology 1979. link90031-4)