Nasal polyps recur after FESS because surgery addresses the anatomical result of the inflammatory process - the polyps themselves - but does not alter the underlying mucosal inflammatory environment that caused them to form. The dominant inflammatory mechanism in most nasal polyp disease is eosinophilic inflammation, often with an allergic or immune component, and this mechanism continues to drive new polyp formation after surgery if it is not treated. The most effective strategy for reducing recurrence after FESS is consistent use of topical nasal corticosteroid sprays post-operatively, initiated as soon as healing allows and continued long-term, combined with formal allergy evaluation. If a specific allergen sensitisation is identified as a driver of the chronic nasal inflammation, addressing it through allergen avoidance and where appropriate allergen immunotherapy can substantially reduce the rate at which polyps regrow. The patients who do best in the long term after FESS for nasal polyps are those who are compliant with post-operative medical management and whose allergic component has been identified and treated. Patients who have surgery and then discontinue nasal steroids, or whose allergy has never been evaluated, tend to experience earlier polyp recurrence.
Written by Dr. Rajendran Dinesh Kumar, MBBS, MS ENT, AASC (Allergy Asthma Specialist Course), FAAP, Consultant ENT Specialist and Allergy, Asthma Specialist, Trustwell Hospitals Pvt. Ltd., JC Road, Vinobha Nagar, Sudhama Nagar, Bengaluru, Karnataka 560002. 16+ years, 20,000+ patients. Phone: 9620928650.
