IMPROVEMENT OF METHODS FOR DIAGNOSIS AND TREATMENT OF CHRONIC POLYPOSIC ETTOMOYITIS

Аннотация

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition of the nasal passages and sinuses, significantly impacting patients' quality of life. Traditional treatment approaches, including corticosteroids and endoscopic sinus surgery, often provide limited and temporary relief. Recent advancements in biologic therapies targeting specific inflammatory pathways have shown promise in managing severe cases of CRSwNP. This article reviews current diagnostic methods, evaluates emerging treatment options, and discusses theintegration of biologics into clinical practice. Keywords: Chronic rhinosinusitis with nasal polyps, biologic therapies, dupilumab, mepolizumab, omalizumab, diagnosis, treatment Introduction: Chronic polypoid ethmoiditis, more commonly known as chronic rhinosinusitis with nasal polyps (CRSwNP), is a subtype of chronic rhinosinusitis characterized by persistent inflammation of the nasal and paranasal sinus mucosa, accompanied by the growth of benign polyps, particularly within the ethmoid sinuses. It is a complex and often debilitating condition that affects approximately 1–4% of the global population and significantly impairs the quality of life. Common symptoms include nasal obstruction, loss of smell, nasal discharge, facial pain or pressure, and a reduced ability to taste or breathe comfortably. These symptoms can be long- lasting, frequently recurring even after treatment, and can interfere with daily function, sleep, and overall well-being. The exact etiology of CRSwNP remains multifactorial, involving a combination of environmental exposures, microbial factors, immune dysregulation, and genetic predispositions. Recent research has particularly emphasized the role of chronic type 2 inflammation,characterized byeosinophilicinfiltration, elevated interleukin levels (notably IL-4, IL-5, and IL-13), and increased immunoglobulin E (IgE). These immunologic markers have been central todeveloping targeted therapies inthelast decade. Diagnosis traditionally relies on a combination of clinical evaluation, endoscopic examination, and radiologic imaging, primarily through computed tomography (CT) scans. Scoring systems such as the Lund-Mackay score are often used to assess the severity and extent of sinus involvement. Despite standardized diagnostic tools, variability in clinical presentations and overlapping symptoms with other sinonasal disorders can complicate timely and accurate diagnosis. Treatment of CRSwNP has historically focused on pharmacological intervention with corticosteroids and surgical procedures, such as endoscopic sinus surgery (ESS), aimed at removing polyps and restoring normal sinus drainage. While effective in the short term, both methods are often associated with high recurrence rates. As many as 40–60% of patients may experience polyp regrowth within a few years post-surgery, particularly in cases of severe https://ijmri.de/index.php/jmsi volume 4,issue3,2025 370 eosinophilic inflammation or comorbid conditions such as asthma and aspirin-exacerbated respiratory disease(AERD). The emergence of biologic therapies represents a significant advancement in the treatment paradigm of CRSwNP. These agents, including monoclonal antibodies targeting specific cytokines and immune pathways, offer new hope for patients with severe, recurrent, or steroid- resistant disease. Their introduction has marked a shift toward precision medicine in otolaryngology, allowing formore personalized and potentially long-lasting treatment outcomes. Literature review The diagnosis of chronic rhinosinusitis with nasal polyps (CRSwNP) is primarily clinical but is often supplemented by endoscopic and imaging findings. Nasal endoscopy remains the gold standard for detecting nasal polyps and assessing their size and extent. It provides real-time visualization of the nasal cavity and paranasal sinuses, allowing clinicians to identify polyp location and nasal obstruction. The Lund-Kennedy scoring system, a modified version of the Lund-Mackay scoring system, is commonly employed to objectively assess the extent of disease based on endoscopic findings, with a higher score indicating more severe disease [1]. Computed tomography (CT) imaging is crucial in evaluating the sinuses' anatomy and degree of sinus opacification. The Lund-Mackay CT scoring system is used widely in clinical practice, where it quantifies the level of sinus involvement. Recent studies emphasize the importance of these imaging tools in identifying complications and monitoring disease progression, particularly in patients undergoing surgical intervention [2]. Additionally, patient-reported outcome measures (PROMs) such as the Sino-Nasal Outcome Test (SNOT-22) provide valuable insights into the patient's quality of life and the functional impact of CRSwNP. The SNOT-22 includes a range of symptoms from nasal congestion to facial pain and loss of smell, helping to quantify how severely the disease affects daily living. Recen