Remission: does it already exist in chronic rhinosinusitis with nasal polyposis?

Area of Science:

• Otolaryngology-Head and Neck Surgery
• Respiratory Medicine
• Immunology

Background:

• Remission, defined by symptom and marker absence, is a key goal in chronic disease management.
• This concept, established in Rheumatology and Gastroenterology, is gaining traction in Respiratory Medicine for asthma.
• This study explores the applicability of remission as a treatment goal in chronic rhinosinusitis with nasal polyposis (CRSwNP).

Discussion:

• The study reviews literature on remission in CRSwNP, assessing clinical, biochemical, and endoscopic evidence.
• Endoscopic sinus surgery combined with ongoing medical therapy shows potential for achieving remission.
• Factors influencing remission rates include prior surgical history and the presence of comorbidities.

Key Insights:

• Approximately 50% of CRSwNP patients achieve remission with endoscopic sinus surgery and continued medical therapy.
• Primary surgery yields higher remission rates (72%) compared to revision surgery (42%).
• Comorbidities such as asthma and aspirin-exacerbated respiratory disease significantly reduce remission rates to around 23%.

Outlook:

• Defining remission through consensus will guide the development of targeted CRSwNP care strategies.
• Future research aims to achieve sustained symptomatic and endoscopic control, potentially leading to a 'cure' for CRS.
• Optimizing treatment protocols can improve remission outcomes for CRSwNP patients.