Utilization of Corticosteroid Delivery Systems for Treatment of Nasal Polyposis - Episode 4

Guidelines for Diagnosis and Treatment of Nasal Polyposis

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Drs Anju Peters, Naveen Bhandarkar, Andrew White, and Dareen Siri review guidelines and position statements for diagnosis and management of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and Chronic Rhinosinusitis without Nasal Polyps (CRSsNP).

Anju Peters, MD: Thank you very much. Let's move on to the next portion. We'll talk about treatment options for patients with nasal polyps. Naveen, we'll start with you. Several societies have guidelines. We have one in the US that were part of, that are almost going to being ready to be published, there are position statements for diagnosis and treatment of both nasal polyps and CRS without nasal polyps. In considering ENT and allergist both treat this; how do you incorporate these recommendations into your practice?

Naveen Bhandarkar, MD: The guidelines help us identify patients based on certain symptoms. And if you'd like me to summarize, in short, what our guidelines are, I can do that. Basically, it involves a subjective and then an objective component to diagnosis. The subjective involves incorporating 2 of 4 cardinal symptoms. Those are nasal congestion and obstruction, decreased or absent sense of smell, facial pain and pressure, and discharge, which can be discolored or postnasal. And a presence of 2 of those 4 symptoms, at least 2 of those 4 symptoms for at least 12 weeks, or more. And we mentioned earlier, many people have had these symptoms a lot longer than that. The objective component involves identification of inflammation. That can be by physical exam, by nasal endoscopy, or by CT scan, or other imaging. CT scan would be the gold standard. And then treatment would then go through a stepwise algorithm, incorporating the least but shown to be effective, least costly, but shown to be effective medications such as nasal steroid sprays. And the guideline recommendation for assessing nasal polyps is strong. With a short course of oral corticosteroids being recommended for treatment if that is identified. That's sort of the large-scale overview of what we have in our guidelines. Love to hear what others have to say as well.

Anju Peters, MD: With ENT, we have both the US guidelines as well as the European guidelines. We do have allergy guidelines coming out from the Joint Task Force, the American Academy and American college, which I know, like Drew have reviewed as well recently.

Transcript edited for clarity