Chronic Rhinosinusitis With Nasal Polyps (CRSwNP): Pathophysiology and Advances in Treatment Options

The persistent inflammatory condition of sinonasal mucosa known as Chronic rhinosinusitis with nasal polyps (CRSwNP) commonly exists with asthma and allergic rhinitis and aspirin-exacerbated respiratory disease (AERD). The research investigated patient outcomes from CRSwNP treatment through medical and surgical methods with special emphasis on biologics and body mass index (BMI) effects on treatment results. The prospective observational research at Tikrit Teaching Hospital enrolled 200 adult CRSwNP patients from January 2024 through February 2025. The diagnostic evaluation included nasal endoscopy and high-resolution CT imaging as well as Sniffin’ Sticks olfactory testing and histopathological examination and inflammatory biomarker assessment. Medical treatments included corticosteroids, antibiotics, antihistamines, montelukast, and dupilumab in selected cases. Patients who needed surgery received functional endoscopic sinus surgery (FESS). The patients received follow-up care for 12 months through which evaluated their results. The Lund-Kennedy endoscopy scores together with Lund-Mackay CT scores and olfactory scores showed substantial post-treatment improvements (p < 0.001). The treatment of dupilumab resulted in positive responses in 85% of patients who had asthma and AERD. The effectiveness of dupilumab treatment decreased when patients had higher body mass index (BMI). The surgical procedure FESS produced symptom resolution in 90% of patients. The laboratory and histological results demonstrated that the inflammatory response was dominated by Th2 cells and eosinophils. The SNOT-22 scores showed significant improvement during the 12-month period. The treatment of CRSwNP requires a customized combination of medical and surgical interventions to achieve optimal results. The selection of biologic therapy needs to take BMI into account.