Nasal polyposis: an inflammatory condition requiring effective anti-inflammatory treatment

David Chin, Richard J. Harvey*

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    55 Citations (Scopus)

    Abstract

    Purpose of review

    Recent literature in chronic rhinosinusitis with nasal polyps (CRSwNP) has focussed on inflammatory mechanisms underlying the disease. Endotyping the histopathological features of the disease, rather than simple clinical phenotypes, reflects a change in our understanding of the disease and approach to management. This is paralleled by renewed evidence for the need for wide postsurgical access and topical anti-inflammatory therapy.

    Recent findings

    Recent research into patterns of dysfunction in innate immunity suggests a crucial role of respiratory epithelium in mediating the inflammatory response. Elevated interleukins, IL-25 and IL-33, from sinus mucosa in CRSwNP and their interaction via innate lymphoid cells may represent the link between the host-environment interface and T-helper 2 dominated inflammation that characterizes CRSwNP. While thorough immunological profiling of CRSwNP is not routinely available, classification of CRS as eosinophilic (ECRS) or noneosinophilic is practical and correlates with disease severity and prognosis. The practice and utility of endoscopic sinus surgery to create a single neosinus for topical corticosteroid delivery is a logical conclusion founded on the inflammatory basis of CRSwNP/ECRS.

    Summary

    There is mounting evidence for CRSwNP as a predominantly inflammatory disease. Even simple histopathological classification on the basis of degrees of tissue eosinophilia reflects the underlying pathogenic mechanisms with diagnostic and prognostic implications. Optimal treatment involves topical anti-inflammatory therapy delivered locally via a wide, postsurgical corridor.

    Original languageEnglish
    Pages (from-to)23-30
    Number of pages8
    JournalCurrent Opinion in Otolaryngology and Head and Neck Surgery
    Volume21
    Issue number1
    DOIs
    Publication statusPublished - Feb 2013

    Keywords

    • chronic rhinosinusitis
    • corticosteroid
    • endoscopic sinus surgery
    • eosinophilic
    • irrigations
    • ENDOSCOPIC SINUS SURGERY
    • EOSINOPHILIC CHRONIC RHINOSINUSITIS
    • IMMUNE-RESPONSES
    • TISSUE EOSINOPHILIA
    • DENDRITIC CELLS
    • SEVERE ASTHMA
    • EXPRESSION
    • IRRIGATION
    • TSLP
    • PATHOGENESIS

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