Ergebnisse einer Umfrage zur aktuellen Behandlung der chronischen Rhinosinusitis mit nasalen Polypen

Zusammenfassung

Einleitung Mit einer Prävalenz von 0,55–4% ist die chronische Rhinosinusitis mit nasalen Polypen (CRSwNP) ein relevanter Bestandteil der täglichen Arbeit in deutschen HNO-Kliniken. Ziel der Fragebogen-basierten Datenerhebung war es, den aktuellen Behandlungsstand der CRSwNP in deutschen Krankenhäusern zu erfassen.

Material und Methoden Hierzu erfolgte der Versand von 24 Fragen innerhalb eines anonymisierten Onlinefragenbogens an deutsche HNO-Kliniken.

Ergebnisse Von 160 angeschriebenen HNO-Kliniken nahmen 50 an der Umfrage teil (31,3%). Davon führten 76% mehr als 100 Nasennebenhöhlenoperationen jährlich und 38% Biologikatherapien an bisher mehr als 50 Patienten durch. Mit 80% bzw. 60% stellten Kochsalzspülungen und intranasale Glukokortikoide (GKS) die häufigsten konservativen Therapiemaßnahmen dar. Systemische GKS-Gaben und nasale GKS-Spülungen waren mit 52% und 20% weniger verbreitet. 80% der Kliniken nutzen Biologika in der Therapie der CRSwNP, wovon 70% Dupilumab bevorzugten. Zur Therapie bei Aspirin (ASS) -Intoleranz wurden in 52% Biologika einer Desaktivierung mit ASS (26%) vorgezogen. Vor Biologikagabe wurden in 90% der Nasal Polyp Score, in 84% der SNOT-22-Fragebogen, in 60–72% Surrogatmarker einer Typ-2-Inflammation und in 50% eine Computertomografie der Nasennebenhöhlen (CT NNH) bestimmt bzw. angefertigt. Der abschließende Therapieerfolg wurde in 50% nach 24 Wochen bewertet.

Schlussfolgerung Zumeist folgten die antwortenden Kliniken den deutschen und europäischen Empfehlungen zur Diagnostik und Therapie der CRSwNP. Die Therapie mit Biologika ist mittlerweile weit verbreitet. Die häufige präoperative Gabe systemischer GKS und Durchführung einer CT NNH vor Therapiestart mit einem Biologikum sind bei aktuell weiter Verbreitung diskutabel.

Abstract

Introduction With a prevalence of 0.55% to 4%, chronic rhinosinusitis with nasal polyps (CRSwNP) is a relevant part of the daily work of German otolaryngologists. The aim of the questionnaire-based data collection was to assess the current treatment status of CRSwNP in Germany.

Material and Methods For this purpose, 24 questions within an anonymized online questionnaire were sent to all German ENT departments.

Results Of 160 contacted ENT departments, 50 participated in the survey (31.3%). Among these, 76% performed more than 100 sinus surgeries annually and 38% treated more than 50 patients with biologics. Saline irrigations (80%) and intranasal glucocorticoids (GCS, 96%) were the most common conservative therapies. Systemic GCSs (52%) and intranasal GCS irrigation (20%) were less common. 80% of departments used biologics in the therapy of CRSwNP with an overall preference for dupilumab (70%). For therapy of aspirin intolerance, biologics (52%) were preferred to aspirin desensitization (26%). Prior to treatment with biologics clinical workup included the nasal polyp score (90%), the SNOT-22 questionnaire (84%), surrogate markers of type 2 inflammation (60%-72%), and computer tomography (50%). Final treatment success was assessed after 24 weeks (50%).

Conclusion Mostly, the responding departments followed German and European recommendations for diagnosis and therapy of CRSwNP. Therapy with biologics is widely used. The value of preoperative systemic GCS and the frequent performance of CT before initiation of therapy with a biologic should be debated in regard to its currently widespread use.

Schlüsselwörter

chronische Rhinosinusitis mit Polyposis nasi - CRSwNP - Umfrage - Typ-2-Inflammation - Diagnose - Therapie - Biologika

Keywords

Chronic Rhinosinusitis with Polyposis nasi - CRSwNP - biologics - survey - diagnostics - therapy

Publication History

Received: 13 September 2023

Accepted: 27 December 2023

Article published online:
02 April 2024

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