Surgical treatment of nasal polyposis in patients with aspirin intolerance.

It is not fully understood why humans possess paranasal sinuses and for many years there has been speculation as to their physiological significance. Much the same uncertainty holds true for the pathophysiology of chronic paranasal sinusitis, a disease which represents a major therapeutic challenge despite recent medical and surgical progress. 3 There are probably several distinct subtypes of chronic paranasal sinusitis ranging from remote mucosal thickening to diVuse polyposis. All types of symptomatic chronic sinusitis call for surgical intervention if medical treatment fails. Corresponding to the diversity of chronic sinusitis, diVerent microsurgical operative techniques have been developed during the last 15 years, all of which share the endonasal access route. Transfacial or transoral surgery has therefore become obsolete for treatment of uncomplicated paranasal mucositis. Many cases with circumscribed hyperplastic changes of the remote paranasal sinus mucosa need only limited surgery of the superordinate anatomical ostiomeatal unit. Removing defined microanatomical narrow passes around this functional key area of the middle nasal meatus (“isthmus surgery”) facilitates drainage and ventilation of the dependent paranasal sinuses (fig 1). Even severe changes in the peripheral sinus mucosa may heal subsequently without being specifically treated. 5 Other cases of diVuse polypoid sinusitis represent a unique disease which is less influenced pathogenetically by local microanatomy and, as a result, does not respond adequately to mere “isthmus surgery”. A more aggressive surgical approach is called for which, nevertheless, should take into account the maximum conservation of nasal physiology. The most severe mucositis associated with analgesic intolerance falls into this category of sinusitis.