Our Summary

This research paper explores the management of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), a condition in which polyps (small growths) are visible in the middle part of the nasal cavity. These polyps are found in approximately 0.2 to 4% of the general population, while up to 15% of people with asthma have nasal polyps, and up to 45% of people with nasal polyps have asthma.

The common treatment for CRSwNP primarily involves medication, while surgery is usually reserved for severe cases that don’t respond to medical treatment. The surgical procedures range from simple polyp removal to more advanced methods such as endoscopic sinus surgery or complete nasal reshaping, which involves removal of the middle structures in the nose.

The study reviews existing literature on both medical and surgical treatments for CRSwNP, focusing on their outcomes, complications, cost-effectiveness, and the best time to perform surgery. Both medical and surgical treatments have similar outcomes, but there’s enough evidence to justify surgery if symptoms don’t improve with medication. However, there isn’t enough evidence to determine the best timing and scope of surgery.

FAQs

  1. What is the prevalence of CRS with nasal polyps (CRSwNP) in the general population and among asthma patients?
  2. What are the different surgical techniques available for the management of CRSwNP?
  3. When is surgery considered as a treatment option for CRSwNP and how effective is it compared to medical management?

Doctor’s Tip

A helpful tip a doctor might tell a patient about nasal polyp removal is to follow post-operative care instructions carefully, including using saline nasal rinses and avoiding activities that could irritate the nasal passages. It is also important to attend follow-up appointments to monitor healing and ensure the best possible outcome.

Suitable For

Patients who are typically recommended nasal polyp removal are those with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) who have failed to adequately respond to primary medical management. These patients may have symptoms such as nasal congestion, facial pain, decreased sense of smell, and postnasal drip. Additionally, patients with asthma who also have nasal polyps may be recommended for nasal polyp removal, as there is a high prevalence of nasal polyps in this population. Surgical techniques for CRSwNP range from simple polypectomy to more extensive endoscopic sinus surgery, depending on the severity of the disease and the patient’s symptoms. Ultimately, the decision to recommend nasal polyp removal is based on the patient’s individual symptoms and response to medical management.

Timeline

  • Patient experiences symptoms of chronic rhinosinusitis with nasal polyps, such as nasal congestion, postnasal drip, decreased sense of smell, and facial pain or pressure.
  • Patient may undergo various medical treatments, such as nasal corticosteroids, oral corticosteroids, antibiotics, and nasal saline irrigations, to manage symptoms.
  • If symptoms do not improve with medical management, patient may be recommended for nasal polyp removal surgery, such as polypectomy or endoscopic sinus surgery.
  • Before surgery, patient undergoes preoperative evaluation and imaging studies to assess the extent of the nasal polyps and any underlying sinus disease.
  • Patient undergoes nasal polyp removal surgery, where the polyps are removed and the sinuses are opened up to improve drainage.
  • After surgery, patient may experience some discomfort, congestion, and mild bleeding for a few days to weeks.
  • Patient follows postoperative care instructions, such as nasal saline irrigations, nasal corticosteroids, and avoiding activities that may increase the risk of bleeding.
  • Patient follows up with their healthcare provider for postoperative appointments to monitor healing and assess symptom improvement.
  • Patient experiences improvement in symptoms, such as improved nasal breathing, sense of smell, and overall quality of life.

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 process after nasal polyp removal surgery?
  3. Will I need to take any medications or follow a specific treatment plan after the surgery?
  4. How likely is it that the nasal polyps will reoccur after surgery?
  5. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  6. How will nasal polyp removal surgery impact my quality of life and ability to breathe comfortably?
  7. What is the success rate of nasal polyp removal surgery in improving symptoms and preventing recurrence?
  8. How long do the effects of nasal polyp removal surgery typically last?
  9. Will I need to follow up with additional appointments or treatments after the surgery?
  10. Are there any lifestyle changes or precautions I should take to prevent nasal polyp recurrence in the future?

Reference

Authors: Dessouky O, Hopkins C. Journal: Curr Allergy Asthma Rep. 2015 Nov;15(11):66. doi: 10.1007/s11882-015-0566-5. PMID: 26411803