The change in the routine management of nasal polyps in the past 2-3 decades has been fascinating and this review from Charleston covers the topics of systemic treatment, local treatment, perioperative treatment and immunotherapy and touches on the lower airway effects. Few would disagree with the statement ‘aggressive medical and surgical treatment of CRSwNPs (chronic rhinosinusitis with nasal polyps) improves asthma outcomes’, but it deserves repetition. Otolaryngologists would be particularly interested in topical steroid delivery methods such as bioresorbable materials and we are reminded that ‘topical antibiotic use for CRSwNPs is not currently supported by evidence. We are informed that ‘macrolides and doxycycline have anti-inflammatory effects and macrolides also have mucolytic and anti-biofilm properties. Thus it is difficult to attribute any benefit solely to antimicrobial characteristics.’ This is an article for all rhinologists to read. I would be surprised if something here is not new to a reader. 

Evidence-based treatment of chronic rhinosinusitis with nasal polyps.
Schlosser RJ, Soler ZM.
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Edward W Fisher

MA DM FRCS, University Hospitals Birmingham NHS Trust (Heartlands and Good Hope Hospitals); Editor, Journal of Laryngology and Otology.

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