[Therapeutic approach for nasal sinus polyposis]

The multiple etiologies of bilateral naso-ethmoidal polyposis (PNE) make a precise and regulated therapeutic decision difficult. The treatment is chosen after a clinical history, radiology and complete biological investigation. Medical and surgical treatments share the indications. Medical treatment is dominated by local corticotherapy. Its failures and recurrence following its end may suggest general corticotherapy, an efficacious remedy but which carries well known risks. The choice of treatment is guided by whether the characteristics of the polyposis are invalidating or not. The localised forms often respond to local medical treatment. Invalidating polyposis continues to be difficult to treat, especially where there is intolerance to aspirin. Corticotherapy by the general route, even sequential, remains insufficient to be sure of long asymptomatic periods. We suggest for these patients a clear ethmoidal once or twice under local anaesthetic with diazanalgesia. The local treatments associated with corticotherapy and anti histamines help the healing of the operated cavity. Crenotherapy is an useful aid after having obtained clean, permeable nasal fossae. The choice remains empirical and is a function of the group, but it must not include iatrogenic risks greater than those of the illness itself. We report our actual experience.