Management of symptomatic chronic rhinosinusitis with nasal polyposis (CRSwNP)

INCS: intranasal corticosteroids; AERD: aspirin-exacerbated respiratory disease; AFRS: allergic fungal rhinosinusitis; EGPA: eosinophilic granulomatosis with polyangiitis; FESS: functional endoscopic sinus surgery; CT: computed tomography.

* Refer to UpToDate topic on management of CRSwNP for specific regimens.

¶ If nasal sprays are not penetrating adequately, try nasal irrigations, nasal drops, or exhalation delivery system (EDS).

Δ AERD is the triad of CRSwNP, asthma, and respiratory reactions to NSAIDS (refer to UpToDate topic on AERD). AFRS presents as severe CRSwNP with hyperattenuated areas on sinus CT (refer to UpToDate topic on AFRS). EGPA presents with CRwNP, asthma, and peripheral blood eosinophilia (refer to UpToDate topics on EGPA).

◊ Possible treatments include stepping up INCS therapy until symptoms resolve and/or a brief course of antibiotics (nonmacrolide) or oral glucocorticoids. Refer to UpToDate topic on management of CRSsNP for details of regimens.

§ Biologics with proven efficacy for CRSwNP include dupilumab, omalizumab, and mepolizumab. Dupilumab is most effective in the majority of patients, although comorbidities and other factors may also influence the choice of agent. Refer to UpToDate topic on management of CRSwNP for a discussion of choice of biologic therapy.