8
Diagnosis and Treatment
Table 4. CRS Disease States That Warrant Consideration for
Expedited Sinus Surgery
CRS disease
state Description
Medical therapy
response Surgery rationale
Nasal polyps Noncancerous
fleshy sac-like
growths of inflamed
sinonasal mucosa.
It is believed these
develop in response
to sinonasal irritation
or inflammation, but
the exact etiolog y is
unknown.
Polyps shrink in
response to oral
or topical steroids.
Sometimes the
steroids are sufficient
to open the sinus
passages blocked by
the polyps; other
times the blockage
remains or worsens
despite the steroids.
Frequently, polyps
regrow once the
steroid is stopped.
is is most common
when the patient has
nasal polyps involving
multiple sinuses.
a
Biological therapy
can decrease the size
of polyps in some
patients, but not all
patients respond to
or tolerate biological
medications.
Sinus surgery for
chronic rhinosinusitis
with nasal polyposis
(CRSwNP) involves
the immediate
removal of polyps,
halts disease
progression, and
removes tissue to
enlarge the sinus
ostium. Surgery
removes the physical
obstruction of the
sinuses and facilitates
drainage of the
sinuses. Surgery
also enables topical
therapies to get into
the sinus cavities and
permits observation
of/access to these
cavities in the clinic.
Bone erosion Appears as a thinning or
loss of continuation of
sinonasal bone on CT
scan. Believed to develop
from pressure atrophy
from expansile tissue
(i.e., sinonasal polyps)
and/or allergic mucin.
Bone erosion does not
change in response to
oral or topical steroids
or antibiotics. If CRS
disease-causing bony
erosion continues to
progress, then the
bone erosion may also
worsen.
Sinus surgery
immediately removes
the source of the
pressure atrophy and
prevents progression
of bone erosion.
