Nasal polyposis: Advances in diagnosis and management

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic disease which has a significant negative impact on the quality of life (QoL). Despite decades of research, still a group of patients remain symptomatic under current state-of-the-art medical and surgical treatment. This thesis focused on analyzing and thereby optimizing different treatments and obtaining further insight in the pathophysiologic mechanisms of CRSwNP. We describe a trial with mepolizumab, which demonstrates a statistically significant reduction of patients eligible for surgery 4 weeks after the last dose in the mepolizumab group compared with placebo. This suggests that mepolizumab might offer a viable alternative to surgery in a selected group of patients with severe CRSwNP. Furthermore we demonstrate that operating patients with CRSwNP with the microdebrider on top of traditional instruments is safe and very time efficient. We performed a systematic review and meta-analysis of randomised controlled trials for operative outcomes on the perioperative role of corticosteroids. Next we showed that FESS is a very effective and safe treatment in children with CRSwNP even in children with CF. We performed micro-array expression profiling on epithelial cells from CRSwNP patients and healthy controls, where we showed that many of the 27 significantly different genes could be linked to pathogenic mechanisms in neoplasm formation and cell cycle control. Furthermore we showed that the active disease duration of CRSwNP is relatively constant at about eleven years, regardless of the age of onset. This could be a first indication that CRSwNP is a self-limiting disease.