No surgery or nose surgery? CRSwNP - setting the new gold standard (Full Episode)

For decades, surgery of the nose and paranasal sinuses has been the gold standard for the treatment of patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) that are uncontrolled by medical therapy. However, surgery isn't a Panacea. In severe patients, symptoms may return and the disease becomes uncontrolled even with appropriate medical therapy, including surgery. However, have we now reached a stage where new drugs can offer a paradigm shift in the treatment of CRS with Nasal Polyps where surgery is no longer considered the gold standard?

No surgery…. or nose surgery? That is the question. This is the EUFOREA Innovation forum debate on CRS with Nasal Polyps - setting the new gold standard

Chronic Rhinosinusitis with nasal polyps or CRS with NP is a chronic inflammatory condition of the nose and the paranasal sinuses which causes a significant impact on the lives of those
patients affected. It’s estimated to affect about one to four percent of the general population and about 25 to 30 percent of patients with chronic Rhinosinusitis.

There is an underlying inflammatory process at work which is called type 2 inflammation. This means that CRS with NP often presents with comorbidities including asthma and allergies. Patients suffering from CRS with NP experience symptoms of nasal obstruction, smell dysfunction with anosmia, continuous nasal discharge and facial pain. All of these have a massive impact on the patient's quality of life and living with this condition can also profoundly affect people's mental health. Psychological symptoms including depression are common. Additionally, with so many people affected by the disease, there is also a significant economic impact including the cost of providing recurrent Health Care, absenteeism from work and loss of work productivity. Therefore it is vital that we continually improve the care that we can offer to patients with CRS with NP and in turn improve their quality of life.

In this innovation forum, we’ll address the following questions:

5:40 What are nasal polyps and how many people have them?7:30

7:37 What is type 2 inflammation?

8:37 The gold standard was always considered to be sinus surgery in the treatment of uncontrolled CRSI. Can’t the obstructions just be removed?

12:45 Patient experience with CRSwNP

17:12 What are biologics?

19:11 How do biologics actually work and what are the advantages of them?

29:24 With the high cost we need to ensure that we're using biologics for the right patients.
Who benefits the most and who benefits the least?

32:40 How are biologics reimbursed in the United States? Do you have to have sinus surgery first before you can use biologics or does it depend?

34:37 What are the current obstacles for using these biologics in clinical practice?

39:32 What are patient concerns about the safety of these drugs?

42:29 What can be done to lower the costs of biologics?
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📌 EUFOREA is an international non-profit organisation forming an alliance of all stakeholders dedicated to reducing the prevalence and burden of allergies and airway diseases by implementing optimal patient care through education, research and advocacy.
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[voramuj]

CRSWNP can be treated without surgery.
In 2020 I had nasal surgery. I suspect my polyps are result of allergy since 2007.
But in 2021 polyps came back, Otolaryngology doctors suggested another surgery looking to my new CT.
But I have treated them without surgery in only 23 days… by hunger treatment. Full hunger, only herbal tea, some 2-3 tablespoons of olive oil once a day.

That’s it. I can share my CT before and after treatment.

[voramuj]

Hi, in early 2020 I have diagnosed severe CRSWNP. In June 2020 i had surgery. Summer 2021, polyps came back. Doctors suggested another surgery, but I have refused. Somehow i came to one clinic in Uzbekistan, which treats with Hunger treatment. 23 days of hunger, i got out all polyps and other symptoms.
Now Spring 2023 polyps came back (not so fast as first time) and I know how to help myself. Hunger treatment.