Multidisciplinary Care

Patients with CRSwNP often require a multidisciplinary care team to manage their care, including primary care physicians, allergists, and otolaryngologists.¹

Most patients with CRSwNP first consult a PCP about their symptoms.² If CRSwNP is suspected, referral to an otolaryngologist is warranted to perform a nasal endoscopy and confirm the diagnosis.¹ Additional indications for referral to a specialist, either an allergist or otolaryngologist, include:

CRSwNP recurs two to three times/year or persists for several months despite treatment
The patient’s quality of life is significantly affected by the disease or treatment
Significant comorbidities, such as asthma or bronchitis
Suspected allergic or immunologic basis of the disease
Comorbidities including allergies, allergic fungal rhinosinusitis, and aspirin-exacerbated respiratory disease²

While there is general consensus among specialties for CRSwNP patients with mild and severe disease, a specialist’s training may influence their recommendations for patients with moderate disease.³ In these cases, otolaryngologists may recommend surgery sooner, whereas allergists may be more likely to recommend additional pharmacological therapies, including biologics.³ Factors including disease severity, comorbidities, and patient preference should be considered in the decision-making process.³

Even after referral to a specialist, PCPs play an important role in ensuring CRSwNP patients are receiving optimal treatment by supporting communication between patients and all members of their healthcare team.⁴ For example, PCPs can make sure patients clearly understand their treatment plan, are taking their medications as prescribed, and not receiving duplicate testing.⁴

References

Buccheit K, Holbrook E. Chronic rhinosinusitis with nasal polyposis: management and prognosis. UpToDate. https://www.uptodate.com/contents/chronic-rhinosinusitis-with-nasal-polyposis-management-and-prognosis
Peters AT, Spector S, Hsu J, et al. Diagnosis and management of rhinosinusitis: A practice parameter update. Ann Allergy Asthma Immunol. 2014;113:347-385.
Han JK, Bosso JV, Cho SH, et al. Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2021;11:1407-1416.
Vimalananda VG, Dvorin K, Fincke BG, Tardiff N, Bokhour BG. Patient, primary care provider, and specialist perspectives on specialty care coordination in an integrated health care system. J Ambul Care Manage. 2018;41:15-24.

All URLs accessed on 2/13/24.