Nasal Polyposis: Current Trends

Abstract

Nasal polyps (NP) are one of the most common inflammatory mass lesions of the nose, affecting up to 4% of the population. They present with nasal obstruction, anosmia, rhinorrhoea, post nasal drip, and less commonly facial pain. Their etiology remains unclear, but they are known to have associations with allergy, asthma, infection, fungus, cystic fibrosis, and aspirin sensitivity. However, the underlying mechanisms interlinking these pathologic conditions to NP formation remain unclear. Also strong genetic factors are implicated in the pathogenesis of NP, but genetic and molecular alterations required for its development and progression are still unclear. Management of NP involves a combination of medical therapy and surgery. There is good evidence for the use of corticosteroids (systemic and topical) both as primary treatment and as postoperative prophylaxis against recurrence, but the prolonged course of the disease and adverse effects of systemic steroids limits their use. Hence several new drugs are under trial. Surgical treatment has been refined significantly over the past 20 years with the advent of endoscopic sinus surgery and, in general, is reserved for cases refractory to medical treatment. Recurrence of the polyposis is common with severe disease recurring in up to 10% of patients. Over the last two decades, increasing insights in the pathophysiology of nasal polyposis opens perspective for new pharmacological treatment options, with eosinophilic inflammation, IgE, fungi and Staphylococcus aureus as potential targets. A better understanding of the pathophysiology underlying the persistent inflammatory state in NP is necessary to ultimately develop novel pharmacotherapeutic approaches. In this paper we present the newer treatment options available for better control and possibly cure of the disease.

Effect of Topical Furosemide on Intraoperative Bleeding During Functional Endoscopic Sinus Surgery

“…In addition, no complication is found for its long-term consumption. 7 In a study by Kroflic et al, the efficacy of systemic steroids and topical furosemide was compared in patients suffering from polyposis and was treated by oral prednisolone (1 mg/kg) and topical furosemide (6.6 mmol/L solution) a week before surgery. Steroids significantly reduced the number of eosinophils and also improved the olfaction; however, it did not have a significant impact on edema.…”

“…Furosemide by decreasing the stimulation of arachidonic acid production reduces E2 and F2a prostaglandin. 7,8 Furosemide also inhibits the release of cytokines, interleukin 6 and 8, and TNF. 9 Given the use of inhaled furosemide in acute and chronic asthma exerts no serious complications and diuretic effect, 10 the efficacy of topical furosemide in reduction of edema, inflammation, and consequently polyps size, furosemide can be prescribed for reducing the amount of bleeding, for patients who have contraindications of taking systemic steroids.…”

Bilateral Isolated Nasal Polyps Originating from the Uncinate Process: Case Report

“…The medical treatment modalities for nasal polyps are targeted to eosinophilic inflammation, IgE, fungi and Staphylococcus aureus. 7 In our case, surgical treatment including uncinectomy and polipectomy proved definitive treatment. Depending on the case, the treatment of nasal polyps will involve a combination of observation, medical, and surgical treatments.…”

Comparison of Recurrence of Intranasal Polyps Treated with Intranasal Polypectomy versus Steroid Use

“…Long-term use, presents a risk of hypothalamic-pituitary-adrenal axis suppression, cataract formation, growth retardation, nasal bleeding, and, nasal septal perforation. 8 and long term use is contraindicated in patients with asthma, diabetes and in hypertension. 9 The patient may require surgical intervention if severe symptoms of obstruction and infection prove refractory to medical treatment.…”