ABSTRACT
Chronic Rhinosinusitis (CRS) is a complex, multifactorial disease where the structural host, environmental and infectious factors combine to produce a disorder of sustained inflammation falling within neutrophilic, eosinophilic or mixed inflammatory endotypes. The diagnosis of CRS is made by history, physical examination, nasal endoscopy or CT scan. Nasal polyps are found in a subset of patients with CRS (CRSwNP). Multiple inflammatory mechanisms are implicated in the development of nasal polyps. Eosinophilic-mediated inflammation and eosinophilic disease is most usually present, however neutrophilic-mediated pathways and neutrophilic disease predominate in some patients. Aspirin Exacerbated Respiratory Disease (AERD), also known as aspirin-sensitive asthma or Samter’s triad, is characterized by the clinical tetrad of aspirin sensitivity, asthma, nasal polyps and eosinophilia. AERD affects 9.7% of patients with CRSwNP. Medical therapies are central to the management of CRS with and without nasal polyps. Endoscopic sinus surgery remains the treatment of choice for medically refractory CRS with and without nasal polyposis.
