# A Literature Review of the Management of Nasal Polyps: Biologics Combined With Endoscopic Surgery

## TL;DR

This review compares the effectiveness of biologics and surgery for nasal polyps, finding that both improve symptoms but with different long-term benefits.

## Contribution

The paper provides a comparative analysis of biologics and endoscopic surgery for nasal polyps, emphasizing personalized treatment strategies.

## Key findings

- FESS provides faster polyp reduction, while biologics improve olfactory outcomes and reduce steroid use.
- Sequential treatment (surgery followed by biologics) offers better long-term control of nasal polyps.
- Biologics become cost-effective over three years for severe, refractory cases, while surgery is more cost-effective short-term.

## Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory condition commonly linked to other respiratory disorders. Symptoms include nasal obstruction, loss of smell, and facial pressure. Treatment strategies include medical therapy, primarily intranasal corticosteroids and biologics, as well as surgical approaches such as functional endoscopic sinus surgery (FESS). This review compares their efficacy, safety, and long-term outcomes to guide evidence-based management. A narrative literature review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. Databases searched (2020-2025) included PubMed, Scopus, Cochrane, and Embase. Inclusion criteria: adult patients with bilateral nasal polyposis comparing biologics versus endoscopic surgery. Excluded were pediatric studies, neoplastic polyps, or non-comparative reports. Twenty-five studies met the inclusion criteria. Data extracted included interventions, follow-up, outcomes (SNOT-22, olfaction, recurrence), and sample sizes. A third reviewer resolved discrepancies. From 1,520 initial records, 25 studies were selected for inclusion. Findings showed that both FESS and biologics significantly improve SNOT-22 scores and symptom relief. FESS provided faster reduction in polyp burden, while biologics (e.g., dupilumab) offered better olfactory outcomes and reduced corticosteroid use. Recurrence rates post-FESS ranged from 15% to 22%. Sequential strategies (surgery followed by biologics) demonstrated superior long-term control. Cost-effectiveness favored surgery in the short term, while biologics became viable over three years in cases of severe, refractory disease. Both FESS and biologics are effective for CRSwNP, with biologics offering superior olfaction restoration and steroid reduction. Surgery remains essential for rapid relief and anatomical correction. A personalized, multimodal approach based on disease severity, patient comorbidities, and treatment response ensures optimal outcomes. Wider access to biologics and further real-world trials will refine long-term treatment strategies.