Outcomes in Medical and Surgical Treatment of Nasal Polyps

Chronic rhinosinusitis with nasal polyps is a heterogeneous disease with a variety of medical and surgical options available to the patient and provider. Consensus statements and recent trends in outcomes research advocate that treatment be driven by patient-reported outcome measures. To this end, there has been increasing sophistication and nuance in both the outcome instruments themselves, as well as the method in which they are collected and interpreted. This is reflected in concepts such as the minimally clinically important difference and domain stratification, which have helped clinicians understand patient motivations and response to treatment. Medical management with topical and possibly systemic corticosteroids is considered the initial treatment strategy of choice, with endoscopic sinus surgery (ESS) reserved for patients who fail to improve. While there is strong evidence for surgical intervention over continued medical therapy in recalcitrant patients, a variety of additional targeted medical treatments and refinements to the nature and extent of ESS have been proposed to further maximize outcomes. Here, with the understanding that limitations continue to exist in our ability to fully answer many treatment-related questions, we present the current cumulative evidence for a patient-centered and outcomes-focused approach to manage this uniquely challenging disease.