The widely different behaviour of nasal polyp disease between patients is a major feature of rhinology practice and makes counselling of patients difficult when approaching their first operative intervention. Setting aside aspirin sensitivity (Samter’s triad), which is known to be indicative of a patient being in the ‘stubborn’ group of recalcitrant polyps, are there any other indicators? This study looked specifically at the immune mediators and immune profile in 21 cases of ‘first’ polypectomy and 15 cases where previous surgery had been undertaken. They found that some mediators or antibodies were higher in the recurrent polyp group. These included: specific IgE to Staph. Aureus enterotoxin, Eosinophil Cationic Protein (ECP) and interleukin 5 (IL-5) were raised in this group. This indicated a predominant Th2 type of inflammation in the recurrent polyp group. Another study in this issue of the journal showed that tissue eosinophilia and high levels of eosinophilic mucin was associated with recurrence. While this might help us to counsel patients, since medical therapy is likely to be tailored to the individual patient, I am not sure that knowing this helps us in management at this stage.