Pathophysiology and treatment strategy of chronic rhinosinusitis with nasal polyps

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  • Ikeda Katsuhisa
    Department of Otorhinolaryngology, Juntendo University Faculty of Medicine

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Other Title
  • 鼻茸を伴う好酸球性，好中球性，非好酸球性・非好中球性の慢性鼻副鼻腔炎の臨床と病態
  • 慢性鼻副鼻腔炎・鼻茸の病態と治療
  • マンセイ ビ フクビコウエン ・ ハナタケ ノ ビョウタイ ト チリョウ

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Although chronic rhinosinusitis (CRS) is a multifactorial disease in a heterogenous group of diseases with different underlying etiologies and pathophysiologies, European and US studies proposed the classification into four categories, i) acute bacterial rhinosinusitis, ii) CRS without nasal polyps, iii) CRS with nasal polyps (CRSwNP), and iv) allergic fungal rhinosinusitis. The histomorphological patterns of CRSwNP are characterized by Th2-driven immune responses including the predominance of eosinophils and mixed mononuclear cells with a relative paucity of neutrophils. Differing from European and US patients, Japanese patients with CRSwNP are thought to be subdivided into eosinophil-dominant, neutrophil-dominant, and eosinophil- and neutrophil-paucity types. The subclassified categories of CRSwNP were evaluated and supported by the clinical backgrounds such as disease severity, atopic status, recurrence, etc. Furthermore, the expression patterns of inflammatory parameters in each group were compared in order to clarify the immunological characteristics. <br> Treatment strategy for eosinophilic CRS is as follows. Selective patients showing extensive and massive sinonasal pathology were prescribed a 7-day course of oral predonisolone tablets before and/or after endoscopic sinus surgery (ESS). A short-term (3 to 5 days) of oral predonisolone was prescribed when olfactory acuity judged by self smell test was aggravated. Moreover, antibiotics were orally given in the presence of massive purulent nasal discharge. Bacterial infection may play a critical role of recurrent polyps and refractory symptoms during post-ESS follow-up. Moreover, worsening of sinusitis accompanies asthma exacerbation.<br>

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