الفهرس 
Introduction and Aim of the StudyOnly 14 pages are availabe for public view
Abstract
In daily clinical practice of an ENT-Allergology center, different forms of rhinitis, such as allergic, non-allergic, rhinosinusitis with or without nasal polyposis are seen. Therefore, the specialist must adopt increasingly complex diagnostic and instrumental methods for diagnosis and management. In fact, only a detailed diagnosis allows characterizing and optimally treating nasal diseases. The patient should undergo thorough diagnostic work-up, where family history must not be excluded, and accompanied by imaging, functional and immunological evaluations. There is a high “global” familial incidence of allergy, asthma and nasal polyposis, not only between first and second degree relatives (44.9 and 31.9%), but also in third and fourth degree ones (23%). These data confirm the fact that, for some diseases, genetic background plays a crucial role and should be taken into consideration. Nasal polyps are tumour-like, hyperplastic swellings of the nasal mucosa, most commonly originating from it within the ostiomeatal complex, the prevalence is estimated at 0.2% to 4% in worldwide studies, Key to understanding this philosophy is the acknowledgement that both CRSwNP and normal patients are exposed to the same allergens, fungi and bacteria (including Staphylococcus aureus), yet only the first group has a heightened proinflammatory immune response. Recent evidence suggests a crucial role for the epithelial-derived cytokines that mediate the cells of the immune system. Nasal polyps are thought to be a manifestation of chronic inflammation, where they represent the final common pathway of several disease processes, the trigger for which is still unknown. There are numerous theories including hereditary factors, anatomical factors, systemic and local allergy, and infection. Nasal polyps are likely to represent the end result of many different mechanisms and the search for a single etiological factor may be in vain Regardless of trigger, the end result is a failure to mount an appropriate immune response to antigens in the nose and sinuses, resulting in chronic inflammation .The management of chronic rhinosinusitis with nasal polyps involves both medical and surgical approaches and remains a controversial subject. A variety of intranasal corticosteroids form the mainstay of conservative management, with good evidence for their efficacy. A number of randomized, placebocontrolled trials document statistically significant improvements in subjective symptom 13. Summary & Conclusion 108 scores, polyp size and objective nasal flow rates following topical steroid use , Symptoms of nasal obstruction can be controlled in anywhere from 50% up to 80% of patients. However, clinical studies indicate that the management of anosmia is poor, especially when compared with systemic steroids. Adverse effects from nasal steroids are few, and range from epistaxis to headaches and dizziness. Using the more modern formulations, such as fluticasone or mometasone, there is minimal systemic absorption and the dose is well below that required for adrenal suppression. A meta-analysis to assess the effectiveness of topical steroids has shown that intranasal corticosteroids are effective in the treatment of rhino sinusitis and that prior sinus surgery and direct sinus delivery methods enhance their effectiveness, Systemic steroids (often termed medical polypectomy) have also shown to be effective. (Alobid 2012; Vaidyanathan 2011) Two randomised controlled trials comparing placebo to systemic steroids show benefit with oral prednisolone, the use of oral steroids is limited by their toxicity, with adverse effects including weight gain, immunosuppression and adrenal suppression. A Cochrane review supports the use of systemic steroids in the treatment of nasal polyposis. A recent systematic review by Poetker et al identified five RCTs supporting the use of oral steroids in the short-term management of CRSwNP Conclusion 1. Curative treatment is hard to achieve in polyposis, management is primarily aimed at reducing symptom severity. It is therefore important to include a measurement of health-related quality of life when assessing the severity of disease or outcome of treatment. 2. Nasal polyps are not associated with allergy but can be associated with asthma, aspirin sensitivity, cystic fibrosis, allergic fungal sinusitis (AFS) and Churg-Strauss syndrome. 3. Unilateral polyps may be a sign of malignancy and should be proper investigated. 4. Children with nasal polyps should be referred for further testing for cystic fibrosis. 5. Aspirin sensitivity should be suspected in severely affected polyp patients, especially those with recurrent polyps and intrinsic asthma. 13. Summary & Conclusion 109 6. Phenotypic of all patients is mandatory. 7. The appropriate management for nasal polyps must focus on controlling the common inflammatory process rather than on treatment of polyps perse. 8. All patients should have a trial of medical treatment before surgery unless the nature of the polyps is in doubt. 9. The goal of sinus surgery is to create permanent wide access for long-term topical therapy.