Relapses After Surgery and Their Prevention

Nasal polyposis is an inflammatory disease that occurs in 1–4% of the general population and about 25–30% of patients with chronic rhinosinusitis (CRS). Despite their appearance, nasal polyps are not to be considered simple edema but are more likely an inflammatory growth of the mucosa of the lateral wall of the nose, which represents a common endpoint in several disease processes. Relapses of nasal polyps after surgical treatment are very common, and their prevention is the focus of interest for clinicians and researchers. Corticosteroids are able to control several steps of the inflammatory cascade. Local corticosteroids are effective in preventing nasal polyp relapses. An update on biologic therapy during the last 10 years is mandatory, even if we are far away from a stated therapeutic pathway in nasal polyposis and relapse prevention. Still, nowadays, there is a strong need for phase III trials for biologics in CRS with nasal polyposis (CRSwNP) in terms not only of efficacy but also of prolonged treatment and duration of efficacy after treatment; therefore, we highlight that at the moment, the efficacy and safety of biologics for patients with CRSwNP are far from being clarified. Even if no data on the efficacy of 18-β-glycyrrhetinic acid in the prevention of nasal polyposis recurrence is present, this compound should be considered as an anti-inflammatory ancillary treatment, together with intranasal corticosteroids, as part of personalized integrated therapy for patients with severe CRSwNP and asthma comorbidity. In aspirin-sensitive subjects, changes in arachidonic acid metabolism are involved in the pathogenesis of nasal polyps: undergoing aspirin desensitization and administering incremental oral doses to reach the maintenance dose could be an option. Inhaled furosemide in preoperative management of nasal polyposis is as effective as conventional oral steroids treatment on subjective improvement of nasal symptoms and polyp size reduction; it is more effective on edema, showing no influence on eosinophil count reduction. Matrix metalloproteinases (MMP) are involved in the tissue remodeling processes of nasal polyp growth, and doxycycline has been demonstrated to inhibit MMP-9. A placebo-controlled, randomized study of nasal polyposis is currently in progress. The administration of antibiotics to patients who have previously undergone surgery for nasal polyposis could help prevent relapses. Macrolide antibiotics have been shown to decrease the virulence of colonizing bacteria and exhibit anti-inflammatory activities. More structured studies are needed on the use of biological therapy. Personalized and integrated treatment (biological agents + intranasal corticosteroids + anti-inflammatory ancillary treatment) should be provided.