Our Summary

This research paper discusses chronic rhinosinusitis (CRS), a long-term inflammation of the sinuses and nasal cavity. CRS is divided into two types: with or without nasal polyps. The standard treatments are steroids and antibiotics, and if these don’t work, surgery might be needed.

The authors talk about the development of endotypes, which are subtypes of a condition defined by distinct features related to the cause and development of the disease. In this case, the endotypes are based on different immune responses associated with CRS. Understanding these endotypes can help predict how the disease will progress, what the risks might be, and guide personalized treatment, including medication, surgery, and new treatments with biologics.

The surgical methods can range from traditional sinus surgery to more extensive or “reboot” approaches. The “reboot” approach aims to completely remove the inflamed lining of the sinuses and replace it with healthy tissue.

The biologics, or biological therapies, they are exploring aim to target specific immune responses involved in CRS, with a focus on certain proteins called cytokines and IgE. The preliminary results from early-stage trials are promising, and more advanced trials are ongoing.

The authors conclude by emphasizing the need for integrated care pathways. These are plans for managing a patient’s care that take into account these new discoveries and treatments. These would make it possible to provide more personalized, effective care for patients with CRS.

FAQs

  1. What are the different surgical approaches to nasal polyp removal mentioned in the article?
  2. How do biologics target type 2 cytokines in the treatment of CRS with nasal polyps?
  3. What are the potential benefits of endotype-driven integrated care pathways in managing chronic rhinosinusitis (CRS) with nasal polyps?

Doctor’s Tip

One helpful tip a doctor might tell a patient about nasal polyp removal is to follow post-operative care instructions carefully, including using prescribed nasal sprays or rinses, avoiding activities that could increase nasal pressure (such as straining or heavy lifting), and attending follow-up appointments to monitor healing and ensure proper recovery. It is also important to avoid irritants or allergens that could trigger inflammation and recurrence of nasal polyps.

Suitable For

Patients with chronic rhinosinusitis (CRS) with nasal polyps are typically recommended nasal polyp removal. These patients may have tried glucocorticosteroid and antibiotic treatments without success, and surgery may be necessary to improve symptoms and quality of life. Patients who have severe symptoms such as nasal congestion, loss of smell, facial pain or pressure, and recurrent sinus infections may benefit from nasal polyp removal. Additionally, patients who have large or multiple nasal polyps that do not respond to other treatments may also be recommended for surgery. It is important for patients to consult with an ENT specialist to determine the best treatment approach for their individual case.

Timeline

Before nasal polyp removal:

  • Patient experiences symptoms of chronic rhinosinusitis, such as nasal congestion, facial pain, and reduced sense of smell
  • Patient may undergo treatment with glucocorticosteroids and antibiotics
  • If symptoms persist, patient may be recommended for nasal and sinus surgery based on endoscopic and computed tomographic scan findings

After nasal polyp removal:

  • Surgery is tailored to completely remove dysfunctional and inflamed mucosa and replace it with healthy mucosa
  • Patient may be prescribed biologics targeting type 2 cytokines IL-4, IL-5, and IL-13, as well as IgE
  • Phase I and II study results show promise for biologic treatments
  • Phase III studies are currently underway to further evaluate effectiveness
  • Development of endotype-driven integrated care pathways for the management of chronic rhinosinusitis with nasal polyps is needed to incorporate these innovations into patient care.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with nasal polyp removal surgery?
  2. How long is the recovery period after nasal polyp removal surgery?
  3. Will I need to follow any specific post-operative care instructions?
  4. Are there any alternative treatments or medications I should consider before opting for surgery?
  5. How likely is it that the nasal polyps will return after surgery?
  6. Are there any lifestyle changes or preventive measures I can take to reduce the likelihood of nasal polyp recurrence?
  7. Will I need to undergo any follow-up appointments or tests after the surgery?
  8. What type of anesthesia will be used during the surgery?
  9. How experienced are you in performing nasal polyp removal surgeries?
  10. Can you explain the specific surgical technique you plan to use for my case?

Reference

Authors: Bachert C, Zhang N, Hellings PW, Bousquet J. Journal: J Allergy Clin Immunol. 2018 May;141(5):1543-1551. doi: 10.1016/j.jaci.2018.03.004. PMID: 29731100