[Rational treatment of nasal polyposis] Trattamento ragionato della poliposi nasale

Despite the therapeutical advances of the last decade, nasal polyposis represents
still a problem for rhinology, practitioners. A number of hypotheses have been
formulated about its etiopathogenesis, but no one is confirmed, so that nowadays
therapy continues to be only symptomatic and does not cure definitively the
underlying pathology. Recurrences are frequent and discourage both the
practitioner and the patient. Purpose of this paper is to illustrate Authors'
therapeutical rationale aimed to reestablish nasal flow, reduce rhinorrhea,
improve olfaction, decrease rhinosinusinusal infection rate and maintain as long
as possible such a symptomatic improvement. These targets are best achieved by a
combination of medical and surgical treatments in order to optimize the results
and reduce the side-effects of both the therapeutical options. Moreover the
treatment should be tailored on each patient and follow up should be careful and
performed at regular interval. Authors reviewed the clinical records of patients
who underwent surgery for nasal polyposis between 2002 and 2004 at Ospedale di
Circolo e Fondazione Macchi, University of Insubria, Varese, Italy, with a
minimum follow-up of 12 months. All patients underwent the complete set of
diagnostic work-up. The choice between surgical or medical options was based on
both the kind of the polyposis and the staging of the pathology. The therapy was
as more "personalized" as possible, but a homogeneity of treatment was
maintained. The results show that a correct "staging" of the patient allows an
appropriate therapy and reduces recurrence rate. In conclusion, authors report
their experience and propose a scheme of diagnostic work-up in order to define
grading/staging of the pathology and establish a "tailored" therapeutic protocol
aimed to control a pathology which is rarely definitively treated.