Overview of Nasal Polyposis

Anju Peters, MD: Hello and welcome to this peer exchange titled utilization of corticosteroid delivery systems for treatment of nasal polyposis. I'm Dr Anju Peters from Northwestern University Feinberg School of Medicine in Chicago, Illinois. Joining me today are 3 of my colleagues. And I'll have them introduce themselves. We'll start with Dr Naveen Bhandarkar.

Naveen Bhandarkar, MD: Hello, everybody. I'm Naveen Bhandarkar from the University of California, Irvine.

Anju Peters, MD: Thank you for joining us. And Dr Drew White?

Andrew White, MD: Hi everyone. Drew White. I'm an allergist/immunologist at Scripps Clinic in San Diego, California and I run our aspirin exacerbated Respiratory Disease Center.

Anju Peters, MD: Thank you for joining Drew. And finally, Dr Dareen Siri.

Dareen Siri, MD, FAAAAI, FACAAI: Thank you for allowing me to participate. My name is Dr Siri. I'm at Midwest allergy sinus asthma just south of Dr Peters, and I run a research center, I am affiliated with Southern Illinois University.

Anju Peters, MD: Thank you for joining, Dareen. Our discussion today will focus on nasal polyposis and its management by various specialist. Today we have allergist in ENT. We will focus on the use of corticosteroids and how corticosteroid delivery systems are being used today for treatment of chronic rhinosinusitis with and without nasal polyps, focusing mostly on nasal polyps. Welcome everyone. Let's get started. Let's start with an overview of nasal polyposis. For that, let's talk about chronic rhinosinusitis. What is chronic rhinosinusitis? Chronic rhinosinusitis is inflammation of the nose and the sinuses for 12 weeks or longer. Six to 12% of the population is affected by chronic rhinosinusitis, so quite common. And the way we diagnose chronic rhinosinusitis is based on symptoms and objective evidence of disease. Symptoms include nasal congestion, drainage, interior or posterior, facial pressure headaches, and decrease our loss of sense of smell, and objective evidence could either be by endoscopy or by a sinus CT. Out of all chronic rhinosinusitis, about 80% of chronic rhinosinusitis without nasal polyps are often will abbreviate it as CRSsNP, and 20% is with nasal polyps, often abbreviated as WNP. About 2 to 4% of the population has nasal polyps. Let's talk start with you, Dr Bhandarkar. What causes nasal polyps? Are there any risk factors that you're aware of?

Naveen Bhandarkar, MD: That's a loaded question. And we all sort of understand now that nasal polyps obviously, are an inflammatory disease, first and foremost. But unfortunately, despite a lot of ongoing research, I don't think we understand the cause. Now, we do know that there are a lot of associated disease states, many people but not all. People with nasal polyps may have eosinophils as part of the disease process, and those can be associated with things like asthma, allergic rhinitis, aspirin, exasperated respiratory disease, allergic fungal sinusitis, even patients with cystic fibrosis can have polyps. And we've seen associations in other ciliary, these motility disease states, and obstructive sleep apnea. But at the end of the day, we don't know the exact cause.

Anju Peters, MD: That makes sense. A lot that we think of it as inflammation. And hopefully, we will get some, you know, with some future research know much more about the risk factors and causes.

Transcript edited for clarity