Update on the molecular biology of nasal polyposis.

The definition of CRS with and without nasal polyposis continues to evolve. It may require an understanding of a broader range of etiologies and pathogenesis than bacterial or viral infection. One must know whether the inflammation is of infectious or noninfectious origin. Therapeutic options will include pharmacotherapies and surgery. The pharmacotherapeutic approach will include antibiotics, systemic and topical steroids, possibly antifungals, novel anti-inflammatory therapies such as the use of antibodies directed against inflammatory cytokines and antileukotrienes, and perhaps low-dose macrolide therapy. In the case of massive nasal polyposis, modern surgical techniques will have to be performed before these therapeutic options will be possible. Finally, the use of topical diuretics such as amiloride and furosemide has been studied and the initial responses seem to be encouraging.