An adult has severe bilateral chronic rhinosinusitis with nasal polyps despite adherence to topical therapy and previous appropriate endoscopic sinus surgery. Asthma remains difficult to control. What is the best next principle?
Severe uncontrolled type-2 inflammatory disease after appropriate medical and surgical treatment warrants specialist reassessment. Biologics may be considered using objective severity, systemic-steroid exposure, smell, asthma and quality-of-life criteria.
A. Repeat identical surgery without reassessing inflammatory phenotype: Revision surgery may help selected anatomical disease but should not be automatic in systemic type-2 inflammation.
B. Stop topical intranasal corticosteroids: Topical anti-inflammatory treatment generally remains foundational even when advanced therapy is added.
C. Multidisciplinary assessment for phenotype-directed additional therapy, including biologic eligibility: Severe uncontrolled type-2 inflammatory disease after appropriate medical and surgical treatment warrants specialist reassessment. Biologics may be considered using objective severity, systemic-steroid exposure, smell, asthma and quality-of-life criteria.
D. Use indefinite antibiotics solely because polyps recur: Polyp recurrence is not evidence of chronic bacterial infection requiring indefinite antibiotics.
E. Offer total turbinectomy: This does not treat the underlying diffuse inflammatory disease and creates avoidable morbidity.
If unilateral polypoid disease with bleeding or bony destruction were present, biopsy and tumour exclusion would precede biologic consideration.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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