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Chronic Rhinosinusitis with Nasal Polyps

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Introduction ➤ Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the nasal mucosa and sinuses that lasts at least 12 weeks. ➤ CRSwNP affects about 2–4% of people with symptoms such as smell loss, nasal obstruction, thick nasal drainage, and facial pressure. ➤ Some patients with CRSwNP also have comorbid asthma and develop acute respiratory reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). Table 1. Topical Steroids Intranasal corticosteroid (INCS) delivery type Description Usual administrator Stent Steroids are found within the matrix of a device implanted in the nasal cavities and are gradually released over a timespan following the operation. e implant exerts a mechanical function in maintaining sinus patency. e implanted device is either absorbed by the mucosae or is surgically removed. Administered by surgeons intra-operatively Spray Corticosteroids are suspended in an aqueous medium with varying concentrations. e delivery is entirely self-administered, with the patient having to press the applicator aer clearing the nostrils and assuming a proper head position. Self-administered Rinse Steroids are suspended in a saline solution. e compound is first inserted into a recipient (i.e., syringe, bottle) and then squeezed into a nostril, having the head tilted sideways. e process is repeated for both nostrils several times as instructed either by study investigators (if in a trial) or by the treating physician. Self-administered Exhalation delivery system (EDS) Corticosteroids are suspended in an aqueous medium. e delivery system uses the patient's exhaled breath to propel medication into the inner nose. By exhaling through the EDS, the patient physiologically seals the so-palate, isolating the nose from downstream airways, preventing drug dispersion. Requires specific device and some basic training. Drops Corticosteroids within an aqueous suspension. A proper administration requires patients to adopt and maintain specific body postures as described either by study investigators (if in a trial) or in the patient information leaflet. e daily dose can either be split between nostrils or administered into a single nostril per day, alternating between the two. Self-administered. Requires specific instructions.

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