Chronic Rhinosinusitis with Nasal Polyps: Novel Concepts, Treatment and Research

Dear Colleagues,

Nasal polyps refer to protrusions of inflammatory sinonasal mucosa into the nasal cavity and affects 20 to 40% of chronic rhinosinusitis patients. The major morbidity from nasal polyps occurs due to nasal obstruction, reduced sense of smell and chronic inflammation, resulting in a significant impact on patient quality of life. Lower respiratory tract symptoms, including asthma, occur in 40–60% of nasal polyp patients. The clinical disease severity and response to treatment varies among patients, ranging from self-limiting to chronic and recalcitrant inflammation. For most patients, the cause of nasal polyps is not known. Some disease associations include fungal hypersensitivity, aspirin exacerbated airways disease, allergy, chronic inflammation, cystic fibrosis and primary mucociliary dysfunction. The mainstay of treatment is glucocorticosteroids, anti-allergy therapy and surgery, however recurrence rates are high. The nasal polyp mucosa typically shows epithelial disruption, changes in basement membrane and is enriched with inflammatory cells, particularly eosinophils and lymphocytes; cytokines, characteristics of Type 1, Type 2, and Type 17 inflammation, and those involved in tissue remodelling; altered balance of eicosanoid and lipid mediators and increased immunoglobulins. The current evidence suggests an interplay of specific patient factors, such as genetic susceptibility and environment, including their microbiome and epigenetic events that create a unique environment that defines individual disease severity, response to therapy and prognosis. The future of nasal polyp treatment is likely to depend on the power of new diagnostic tools and biomarkers that define specific subgroups of nasal polyp patients and potential new “non-glucocorticosteroid”-based therapies which will be explored in this issue. This Special Issue will focus on new discoveries of the mechanisms underlying nasal polyposis, a practical approach to patient stratification, surgical and medical treatment of nasal polyps and co-morbidities, and clinical outcomes.

Dr. Harshita Pant
Guest Editor

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• nasal polyps
• treatment
• molecular mechanisms
• sinusitis
• eosinophilic
• allergic fungal rhinosinusitis
• aspirin exacerbated airways disease
• cystic fibrosis
• microbiome
• allergy