Management of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the Pan-Arab Region: Consensus Recommendations from a Multidisciplinary Expert Working Group

Osama Marglani,1,2 Rashid Al Abri,3 Mona Al Ahmad,4 Saad Alsaleh,5 Mohamed Abuzakouk,6 Reda Kamel7 1Department of Ophthalmology, and Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 2Department of Surgery, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia; 3Sultan Qaboos University Hospital, Muscat, Oman; 4Al-Rashed Allergy Centre, Kuwait, State of Kuwait; 5Rhinology and Endoscopic Skull Base Surgery Division, Otolaryngology – Head and Neck Surgery Department, King Saud University, Riyadh, Saudi Arabia; 6Department of Allergy and Immunology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; 7Department of Otorhinolaryngology, Cairo University, Cairo, EgyptCorrespondence: Osama Marglani, Department of Surgery, King Faisal Specialist Hospital & Research Center, Jeddah, 23431, Saudi Arabia, Email omarglani1@gmail.comAbstract: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic and often debilitating inflammatory condition of the nasal and paranasal tissues. An expert panel of specialists from the Gulf region (the Kingdom of Saudi Arabia, Kuwait, Oman and the United Arab Emirates) and from Egypt gathered to evaluate existing guidance and develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the main observations and recommendations from this panel. CRSwNP diagnosis requires the presence of bilateral, endoscopically visualized polyps in the middle meatus (via nasal endoscopy or CT). In most patients, CRSwNP is mediated through predominantly type 2 inflammatory processes and is often observed in patients with asthma and other allergic disease. While many patients respond to medical treatment (principally topical irrigation and intranasal corticosteroids, and adjunctive short-term use of systemic corticosteroids), clinical management of CRSwNP is challenging, and a multidisciplinary approach for complete evaluation and treatment is recommended. Patients with more severe/uncontrolled disease (despite adequate medical therapies) require a complete endoscopic sinus surgery (ESS), although outcomes can be unsatisfactory, and further revision surgery is common. Biological therapies targeting underlying inflammatory processes offer additional, effective treatment options for those patients with persistent symptoms despite complete ESS, and also in those patients where surgery may be contraindicated.Keywords: chronic rhinosinusitis with nasal polyposis, CRSwNP, type 2 inflammation, biologics