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Treatments, Remedies Evolving for Difficult Nasal Polyposis


Nithin Adappa, MD (left), discusses treatments during a session led by Bradford A. Woodworth, MD, (right).

Otolaryngologists often see chronic sinusitis patients with nasal polyposis. Through case scenarios of difficult patients, international experts in a Tuesday morning Miniseminar discussed how surgeons can better evaluate underlying disease processes and make determinations regarding treatments.

Although surgery and anti-inflammatories are mainstays of management, there are no universally accepted treatment standards. This is partly due to the underlying disease heterogeneity, said Bradford A. Woodworth, MD, who was the moderator of “Difficult Nasal Polyposis: Evolving Treatment and Remedies.” Prior to the session, he shared his thoughts on the Miniseminar.

Douglas Reh, MD, Johns Hopkins University, Baltimore, MD, provided an overview of nasal polyposis and basic treatment strategies, including topical steroid rinses. Nithin Adappa, MD, from the University of Pennsylvania, Philadelphia, PA, discussed advanced and alternative treatment strategies.

“Newer concepts behind difficult nasal polyposis revolve around improved access for topical steroid irrigations. Surgery is just an avenue to allow medical therapy to work more effectively. This may include larger hole procedures, such as the Draf III procedure, which can allow penetration into the frontal sinuses, where nasal polyps tend to start to recur,” said Dr. Woodworth, the James J. Hicks Professor of Otolaryngology, residency program director, and associate scientist at the Gregory Fleming James Cystic Fibrosis Research Center at the University of Alabama at Birmingham School of Medicine.

Jan Gosepath, MD, University of Mainz School of Medicine in Germany, discussed aspirin desensitization and advanced therapeutic strategies for aspirin-sensitive nasal polyposis in Samters triad. He has developed aspirin-desensitization techniques using lower overall doses that have shown excellent results with better control of polyp disease, Dr. Woodworth said.

Dr. Woodworth also shared the latest information on the pathogenesis and treatments for cystic fibrosis nasal polyposis. Because the largest burden of disease in CF patients is in the maxillary sinus, modified endoscopic medial maxillectomies are an excellent surgical treatment strategy that enhances access for topical irrigations and therapy, and permits vastly improved ability to debride CF mucus.

He also looked at new cystic fibrosis medications that target the basic genetic defect, including new a cystic fibrosis transmembrane regulator (CFTR) protein modulator.

“We’re starting to see the results of modulating CFTR and restoring some activity to the protein,” Dr. Woodworth said. “We are at a momentous period in time where these drugs actually target the underlying problem rather than treating the end result of the disease process.”

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