Post Operative Treatment with INS

INS : 8,72,79 - 85
Reduce recurrence Improve nasal symptoms

Mechanism : wound healing following FESS Jorissen & Bachert pilot study87 Patient with NP after FESS; show reduced inflamation and edema

Safety Issues
Systemic cortico steroid usage in NP is limited by side effects of long term ussage.
Side effect : Increased IOP, bone density reduction, and skin thinning

INS ; had low bioavailability and high first pass methabolism >> reduced risk of systemic side effects

Other Treatment Options

Anti hystamine Intranasal Ampotherycin B Capsaicin Furosemide Anti Leukotrienes Lysine Aspirine desensitization Anti IL-5 Warrant further study based by promissing results Anti IG-E Antibodies Mucosal Atomization device

Randomized double-blind study with single injection of Rituzumab (anti IL-5 monoclonal antibody) in 24 patients with nasal polyposis
8 of 16 patients with active treatment showed improved polyp score

Preliminary open-label study of omalizumab (anti Ig-E Antibodies) in 4 patients with allergyc asthma and recurrent nasal polyps

Shrinkage of polyp size ; approximately 20%

conclussions
Symptoms of nasal polyposis associated with substantial economic burden and necative impact on patient quality of live Key role of symptoms => Inflammation, INS are recommended as first line therapy Surgery did not adressed on underlying patophysiology; recurrences are common; warranting post operative control with INS to delay or prevent recurrence. Mainstay treatment that reduce polyp size and number and improve nasal symptoms of the disease has been found to improve quality of live New therapeutic options are emerging for a subgroup of patients with sever ins resistant disease, including mAbs against IL5 & IgE