European Position Paper on Nasal Polyps

Department of Otorhinolaryngology, Amsterdam Medical Centre, P.O. box 22660, 1100 DD Amsterdam, The Netherlands.
Rhinology. Supplement 02/2007; 45(20):1-136.
Source: PubMed


Rhinosinusitis is a significant and increasing health problem which results in a large financial burden on society. This evidence based position paper describes what is known about rhinosinusitis and nasal polyps, offers evidence based recommendations on diagnosis and treatment, and considers how we can make progress with research in this area. Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now rhinosinusitis. Rhinosinusitis (including nasal polyps) is defined as inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip), +/- facial pain/pressure, +/- reduction or loss of smell; and either endoscopic signs of polyps and/or mucopurulent discharge primarily from middle meatus and/or; oedema/mucosal obstruction primarily in middle meatus, and/or CT changes showing mucosal changes within the ostiomeatal complex and/or sinuses. The paper gives different definitions for epidemiology, first line and second line treatment and for research. Furthermore the paper describes the anatomy and (patho)physiology, epidemiology and predisposing factors, inflammatory mechanisms, evidence based diagnosis, medical and surgical treatment in acute and chronic rhinosinusitis and nasal polyposis in adults and children. Evidence based schemes for diagnosis and treatment are given for the first and second line clinicians. Moreover attention is given to complications and socio-economic cost of chronic rhinosinusitis and nasal polyps. Last but not least the relation to the lower airways is discussed.

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Available from: Joaquim Mullol
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    • "Rhinosinusitis was defined as an inflammation of the nasal cavities and the paranasal sinuses and is characterized by two or more symptoms, which should be a nasal blockage, an obstruction, a congestion, or a discharge (anterior/posterior nasal drip), which may have accompanying facial pain/pressure and reduction, or loss, in the sense of smell. These symptoms should be supported by a demonstrable disease that includes any of the following observations: endoscopic signs of nasal polyps, mucopurulent discharge primarily from the middle meatus, edema/mucosal obstruction primarily in the middle meatus, or imaging of mucosal changes within the ostiomeatal complex and/or sinuses.9,10 "
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    • "The flat growth in surgical incidence and penetration rate of BCD-only procedures further suggests a limited role for supplier-induced demand in the time period considered herein. This may be due to the fact that US-based and European rhinologic medical societies recently facilitated the creation and publication of well-defined guidelines.6,18 These medical guidelines alleviate some of the uncertainty in appropriate treatment modalities and thus possibly reduce the variability in individual physician practice styles that were identified before 2006.19 "
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