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Delay for removal of polyps

I have 3-4 time a year sinusitis. My ENT specialist recommended to have the nasal polyps removed but he mentioned, that they will come back and therefore I should wait with the operation as long as possible. Right now, I am treated with steroid-containing nasal spray and if needed antibiotics for oral use.
Now I read about the Pari Sinus device that reaches also the sinuses in contrast to the nasal spray. Would it be possible to achieve a reduction of the nasal polyps with a suitbale drug administerd by the Pari Sinus and therefore to have more time until an operation would be necessary?
low-dose steriod-containing nasal sprays like mometason are the gold-standard for reduction of polyps, with many studies proving that for patients not suffering from CF. Also a CF study was able to prove this, however was too small in order to be taken as a real prove. In general it is assumed that CF polyps with more neutrophil granulocytes react less to steroid nasal sprays than polyps without CF, having more eosinophil granulocytes.
Yes, the nasal spray reaches only the lower nasal concha and polyps often originate from the middle concha or from the sinuses. Therefore the nasal spray does not optimally reach them at the root. We did studies with the Pari Sinus, that showed a significant reduction of symptoms under dornase alpha. We did not investigate the size of the polypes (CT with radiation or a expensive MRT would have been necessary).
Also with 6% NaCl and antibiotics against Pseudomonas wie did CF studies for the sinuses. Also the antibiotics reduced symptoms in patients who are colonized in the upper airways with Pseudomonas. NaCl 6% can irritate a bit, however like in the lower airways the patients appreciate the mucolytic effect and use the device for this.
There are studies which are conducted at the moment from ENT physicians, who have patients not suffering from CF who inhale low-dose steroids (like mometason) via the Pari Sinus in order to reach the roots of the polyps. The project sounds promising and there are positive reactions, however the study has not come to an end yet due to organizational reasons.
In summary, it has been shown (Möller et al.) that vibrating aerosols via the Pari Sinus can reach the sinuses, which is not the case with the nasal spray without vibrations. It would be possible, to inhale with the device e.g. budesonide 1-2 times a day 500µg, in order to reduce the polypes at the root and to prolong the time to a possible operation. This is out of license like many other therapies however.
In case the sinuses have to be operated in patients with CF, a CF experienced physician should do a more radical operation, otherwise the polyps will reoccur within a few months.
Around the operation one should pay attention to a new colonization with Pseudomonas in the upper airways. Afterwards regular nasal washings and sprays with steriods help, to avoid a reoccurence.
Best regards,
Dr. Jochen Mainz