Author(s): Kabikanta Samantaray1, Nishikanta Pradhan2, Rudranarayan Biswal3
Sinonasal polyposis, one of the most common inflammatory mass lesions of the nose affecting up to 40% of the population. They present with nasal obstruction, anosmia, rhinorrhoea, post-nasal drip, and less commonly headache. Their aetiology remains unclear, but they are known to have associations with allergy, asthma, infection, fungus, cystic fibrosis, and aspirin sensitivity. Strong genetic factors are implicated in the pathogenesis of SNP, but genetic and molecular alterations required for its development and progression are still unclear. Management of SNP involves a combination of conservative treatment and surgical treatment. There is good evidence for the use of corticosteroids (systematic and topical), both as primary treatment and as postoperative prophylaxis against recurrence, but the prolonged course of the disease and adverse effect of systematic steroid limits their use. 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 prospective 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 SNP is necessary to ultimately develop novel pharmacotherapeutic approaches. Here, we present the newer treatment options available for better control and possibly cure of the disease.