Medical Management of Nasal Polyps
DOI:
https://doi.org/10.58931/cait.2021.1321Abstract
Rhinosinusitis is characterized by inflammation of the nasal mucosa and paranasal sinuses. Chronic rhinosinusitis (CRS) is an inflammatory disease of unclear origin which is typically marked by eosinophilic, neutrophilic and/or lymphocytic cell infiltration, as well as T helper (Th) cell and type 2 cytokine upregulation (TSLP, IL-25, IL-33, IL-4, IL-5, and IL-13). CRS typically presents as either CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP) as noted previously. Unlike CRSsNP, CRSwNP involves the presence of recurring edema-filled nasal polyps and a significant inflammatory cell infiltrate. Biochemically, CRSwNP has a type 2 inflammatory profile mediated by T-helper 2 cells (Th2) while CRSsNP has a type 1 inflammatory profile predominantly mediated by T-helper 1 cells (Th1).
References
Ahern S, Cervin A. Inflammation and endotyping in chronic rhinosinusitis—a paradigm shift. Medicina (Kaunas). 2019 Apr;55(4):95. doi:10.3390/medicina55040095
Desrosiers M, Evans GA, Keith PK, Wright ED, Kaplan A, Bouchard J, et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. Allergy Asthma Clin Immunol. 2011 Feb;7(1):1-38. doi:10.1186/1710-1492-7-2
Rudmik L. Economics of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2017 Apr;17(4):20. doi:10.1007/s11882-017-0690-5
Stevens WW, Schleimer RP, Kern RC. Chronic Rhinosinusitis with Nasal Polyps. J Allergy Clin Immunol Pract. 2016 Jul-Aug;4(4):565-72. doi:10.1016/j.jaip.2016.04.012
Ahn JC, Kim JW, Lee CH, Rhee CS. Prevalence and risk factors of chronic rhinosinusitus, allergic rhinitis, and nasal septal deviation: results of the Korean National Health and Nutrition Survey 2008–2012. JAMA Otolaryngol Head Neck Surg. 2016 Feb;142(2):162-167. doi:10.1001/jamaoto.2015.3142
Kim DH, Han K, Kim SW. Effect of chronic rhinosinusitis with or without nasal polyp on quality of life in South Korea: 5th Korea National Health and Nutrition Examination Survey Korean. Clin Exp Otorhinolaryngol. 2016 Jun;9(2):150-156. doi:10.21053/ceo.2015.01053
Macdonald KI, McNally JD, Massoud E. The health and resource utilization of Canadians with chronic rhinosinusitis. Laryngoscope. 2009 Jan;119(1):184-189. doi:10.1002/lary.20034
Tan NC, Psaltis AJ. Latest developments on topical therapies in chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2020 Feb;28(1):25-30. doi:10.1097/MOO.0000000000000598
Rudmik L, Hoy M, Schlosser RJ, Harvey RJ, Welch KC, Lund V, Smith TL. Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013 Apr;3(4):281-298. doi:10.1002/alr.21096
Pynnonen MA, Mukerji SS, Kim HM, et al. Nasal Saline for Chronic Sinonasal Symptoms: A Randomized Controlled Trial. Arch Otolaryngol Head Neck Surg. 2007 Nov;133(11):1115-1120. doi:10.1001/archotol.133.11.1115
Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007 Jul 18:CD006394. doi:10.1002/14651858.CD006394.pub2
Fowler J, Rotenberg BW, Sowerby LJ. The subtle nuances of intranasal corticosteroids. J Otolaryngol Head Neck Surg. 2021;50(1):1-6.
Chong LY, Head K, Hopkins C, et al. Different types of intranasal steroids for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016 Apr 26;4:CD011993-CD011993. doi:10.1002/14651858.CD011993.pub2
Kang TW, Chung JH, Cho SH, Lee SH, Kim KR, Jeong JH. The effectiveness of budesonide nasal irrigation after endoscopic sinus surgery in chronic rhinosinusitis with asthma. Clin Exp Otorhinolaryngol. 2017 Mar;10(1):91-96. doi:10.21053/ceo.2016.00220
Neubauer PD, Schwam ZG, Manes RP. Comparison of intranasal fluticasone spray, budesonide atomizer, and budesonide respules in patients with chronic rhinosinusitis with polyposis after endoscopic sinus surgery. Int Forum Allergy Rhinol. 2016 Mar;6(3):233-7. doi:10.1002/alr.21688
Bhalla RK, Payton K, Wright ED. Safety of budesonide in saline sinonasal irrigations in the management of chronic rhinosinusitis with polyposis: lack of significant adrenal suppression. J Otolaryngol Head Neck Surg. 2008 Dec;37(6):821-5.
Welch KC, Thaler ER, Doghramji LL, et al. The effects of serum and urinary cortisol levels of topical intranasal irrigations with budesonide added to saline in patients with recurrent polyposis after endoscopic sinus surgery. Am J Rhinol Allergy. 2010 Jan-Feb;24(1):26-8. doi:10.2500/ajra.2010.24.348
Smith KA, French G, Mechor B, Rudmik L. Safety of long-term high-volume sinonasal budesonide irrigations for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016 Mar;6(3):228-32. doi:10.1002/alr.21700
Soudry E, Wang J, Vaezeafshar R, Katznelson L, Hwang PH. Safety analysis of long-term budesonide nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus surgery. Int Forum Allergy Rhinol. 2016 Jun;6(6):568-72. doi:10.1002/alr.21724
Seiberling KA, Chang DF, Nyirady J, et al. Effect of intranasal budesonide irrigations on intraocular pressure. Int Forum Allergy Rhinol. 2013 Sep;3(9):704-707. doi:10.1002/alr.21180
Schlosser RJ, Soler ZM. Evidence-based treatment of chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2013 Nov-Dec;27(6):461-466. doi:10.2500/ajra.2013.27.3982
Poetker DM, Jakubowski LA, Lal D, Hwang PH, Wright ED, Smith TL. Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013 Feb;3:104–20. doi:10.1002/alr.21072
Hox V, Lourijsen E, Jordens A, Aasbjerg K, Agache I, Alobid I, et al. Benefits and harm of systemic steroids for short-and long-term use in rhinitis and rhinosinusitis: an EAACI position paper. Clin Transl Allergy. 2020 Jan;10(1):1-27. doi:10.1186/s13601-019-0303-6
Mostafa BE, Hay HA, Mohammed HE, Yamani M. Role of leukotriene inhibitors in the postoperative management of nasal polyps. ORL J Otorhinolaryngol Relat Spec. 2005;67(3):148-53. doi:10.1159/000086016
Van Gerven L, Langdon C, Cordero A, et al. Lack of long-term add-on effect by montelukast in postoperative chronic rhinosinusitis patients with nasal polyps. Laryngoscope. 2018 Aug;128(8):1743-51. doi:10.1002/lary.26989
Pauli C, Fintelmann R, Klemens C, et al. Polyposis nasi–improvement in quality of life by the influence of leukotriene receptor antagonists. Laryngorhinootologie 2007 Apr;86(4):282-286. doi:10.1055/s-2007-966094
Schäper C, Noga O, Koch B, et al. Anti-inflammatory Properties of Montelukast, a Leukotriene Receptor Antagonist in Patients With Asthma and Nasal Polyposis. J Investig Allergol Clin Immunol. 2011;21(1):51-8.
Haye R, Aanesen JP, Burtin B, Donnelly F, Duby C. The effect of cetirizine on symptoms and signs of nasal polyposis. J Laryngol Otol. 1998 Nov;112(11):1042-6. doi:10.1017/s0022215100142422
Head K, Chong LY, Piromchai P, Hopkins C, Philpott C, Schilder AG, Burton MJ. Systemic and topical antibiotics for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016 Apr 26;4(4):CD011994. doi:10.1002/14651858.CD011994.pub2
Blaiss MS. Chronic rhinosinusitis with nasal polyps management in the age of biologics. Allergy Asthma Proc. 2020 Nov;41(6): 413-419. doi:10.2500/aap.2020.41.200069
Iqbal IZ, Kao SS, Ooi EH. The role of biologics in chronic rhinosinusitis: a systematic review. Int Forum Allergy Rhinol. 2020 Feb;10(2):165-174. doi:10.1002/alr.22473
Thamboo A, Kilty S, Witterick I, Chan Y, Chin CJ, Janjua A, Javer A, Lee J, Monterio E, Rotenberg B, Scott J. Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis. J Otolaryngol Head Neck Surg. 2021 Mar 9;50(1):15. doi:10.1186/s40463-021-00493-2
Sanofi-aventis Canada. (2020). DUPIXENT®️Canada Product Monograph.
Gevaert P, Calus L, Van Zele T, Blomme K, De Ruyck N, Bauters W, Hellings P, et al. Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma. J Allergy Clin Immunol. 2013 Jan;131(1):110–6.e1. doi:10.1016/j.jaci.2012.07.047
Bachert C, Mannent L, Naclerio RM, Mullo J, Ferguson BJ, Gevaert P, et al. Effect of subcutaneous Dupilumab on nasal polyp burden in patients with chronic sinusitis and nasal polyposis: a randomized clinical trial. JAMA. 2016 Feb 2;315(5):469–79.
Han JK, Bachert C, Desrosiers M, Laidlaw TM, Hopkins C, Fokkens WJ, et al. Efficacy and safety of dupilumab in patients with chronic rhinosinusitis with nasal polyps: results from the randomized phase 3 sinus-24 study. J Allergy Clin Immunol. 2019;143(2):S1A-S4A.
Bachert C, Desrosiers M, Mullol J, Hellings P, Cervin A, Sher L, et al. A randomized phase 3 study, sinus-52, evaluating the efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2019 Feb;143(2):AB433.
Bachert C, Zinreich SJ, Hellings PW, Mullol J, Hamilos DL, Gevaert P, et al. Dupilumab reduces opacification across all sinuses and related symptoms in patients with CRSwNP. Rhinology. 2020 Feb 1;58(1):10-17. doi:10.4193/Rhin18.282
Smith KA, Pulsipher A, Gabrielsen DA, Alt JA. Biologics in chronic rhinosinusitis: an update and thoughts for future directions. Am J Rhinol Allergy. 2018 Sep;32(5):412-23. doi:10.1177/1945892418787132
Bachert C, Zhang N, Cavaliere C, et al. Biologics for chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2020 Mar;145(3):725-39. doi:10.1016/j.jaci.2020.01.020
Fokkens WJ, Lund V, Bachert C, Mullol J, Bjermer L, Bousquet J, et al. EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy. 2019 Dec;74(12):2312-2319. doi:10.1111/all.13875
