Current clinical concepts regarding the diagnosis and therapy of nasal polyposis

Nasal polyps are tumor-like, hyperplastic swellings of the nasal mucous membranes, The histology may vary. The clinical picture shows a great heterogeneity, ranging from single polyps (so-called choanal polyps) to almost complete polypoid transformation of the mucosa in all paranasal sinuses. Nasal polyps may be associated with different inflammatory nasal diseases such es chronic rhino-sinusitis, cystic fibrosis and Katagener's syndrome. The exact pathogenesis of nasal polyps is unknown. Several theories have been formulated over the past 20 years attributing nasal polyps to a variety of causes including allergy, genetic predisposition and inflammation. Recently, a relationship has been demonstrated between the production of cytokines and the formation and activation of inflammatory cells in the polyps. The diagnosis and surgical treatment of nasal polyposis has been decisively developed over the past decade. Current diagnostic and therapeutic concepts are presented for the treatment of nasal polyposis. Precise indications for medical and surgical treatment of nasal polyposis can be derived from an evaluation of the allergic endoscopic and radiological examinations. Glucocorticoids play a dominant role in conservative therapy. Topical application of steroids is the preferred route. Surgical therapy should not be radical. It should focus on the lateral nasal wall rather than on the healthy mucosa of the sinuses itself.