Role of Various Specialists in Diagnosis and Management of Nasal Polyposis

Anju Peters, MD: Dareen, what do you see the role of the primary care physician, allergist as such as yourself, otolaryngologist such as Naveen and the diagnosis and management of nasal polyposis? If you don't mind, if you wouldn't mind just thinking a little bit deeper into those patients who are older who come to see us with this disease?

Dareen Siri, MD, FAAAAI, FACAAI: That's a great question, because certainly the elderly patients, we don't see so many nasal polyps in the younger age. First, is associated with primary ciliary dyskinesia, CF. But the stats are, depending on what you mean by elderly, which is an interesting question, because we know that the incidence of nasal polyposis, you know, rises dramatically 40, and 50, and up. Depending on what you mean by elderly in terms of the age population. You know, the stats are much higher in terms of diagnosis for a variety of factors. Most of the time, these patients are suffering for years at primary care doctors’ offices before they come to see an allergist and an otolaryngologist. And perhaps you know, at some point, they've had been managed as just traditional allergies. And we know some of those patients are not allergic. Certainly, those medications they've tried, the failure of the over the counters, all the time, energy they spent. Finally, they're tired of it. It's great to have a primary care physician who is a partner with us, allergist and otolaryngologist will recognize some of the unusual features of CRS with or without nasal polyps. They will refer, they can get better diagnosis and better treatment from us. And in our community and in many communities, allergist and ENTs work well together in terms of medical management, making the diagnosis. I'm thinking about surgical options. And then certainly linking it back to the pathophysiology to offer you know, newer investigative treatments for these patients as well.

Anju Peters, MD: Education of the primary care physicians is key. And you're right. All throughout, I feel like here in Chicago also, ENT and allergist work together very well. Naveen or Drew, do you have anything else you would like to add?

Andrew White, MD: I would say just you know, professionally, is one of my favorite things is to have that multidisciplinary camaraderie with, for me, with the surgery side, and hopefully it goes back and forth. But from a patient perspective, it works out well for them because they have 2 advocates. They've got 2 experts for their one disease, we're going to see things through some different lenses, but at the end of the day, we both want what's best for the patient. And that's great. You know, that enhances the outcome. I feel like this is a disease that has to be managed together. And that's where I sort of see the role. Both of us have an equally important role.

Anju Peters, MD: I totally agree. How about Naveen, as an ENT?

Naveen Bhandarkar, MD: The challenge for primary care physicians, and probably a lot of allergists too, is the absence of - or inaccessibility of endoscopy in the office, which we obviously have the advantage of. And especially when it comes to polyps, that can make the diagnosis very difficult. And I'm sure we'll touch on this later. But in obvious states, when you see the frank polyp formed in the nose, that's often-easy times to diagnose when it's a little deeper into where the sinus cavities are. Even sometimes it's difficult for us to see. The role of the primary care physician is educationally speaking, helping them identify patients who potentially have these inflammatory disease states looking for certain things in their practice, including failure to respond to medications. If they have access to imaging, then that's great. But that's where we play a key role in helping them treat these patients better and work with us, be available to help them out in this diagnosis as Drew stated.

Anju Peters, MD: I totally agree. And one of the things that I tell my fellows and you know, my colleagues that if we don't have access to scope, at least realizing that the 2 most common symptoms these patients have are nasal congestion, and either hyposmia or anosmia. Loss of sense of smell, and nasal congestion, we should start thinking, could this person have nasal polyps. And then either get a CT or if we have access to endoscopy or have our ENT colleagues see these patients.

Transcript edited for clarity