Navigating challenges in management of difficult-to-treat chronic rhinosinusitis with nasal polyps in the greater Gulf

Chronic rhinosinusitis with nasal polyps (CRSwNP) poses significant management challenges, particularly in treatment-resistant cases, greatly affecting patients' quality of life. This paper provides consensus-based recommendations to guide clinicians in managing difficult-to-treat CRSwNP in the Gulf Cooperation Council (GCC) region. A modified Delphi method was used to gather expert opinions from GCC specialists through surveys and discussions, achieving consensus on 14 key statements for CRSwNP management. Key criteria identified for difficult-to-treat CRSwNP included early recurrence after surgery, comorbid atopic diseases, and frequent need for oral steroids. The importance of structured histopathology reporting and understanding inflammatory characteristics to differentiate patients with CRSwNP was highlighted. The advantages of using new therapies, such as biologics, were acknowledged in managing patients who do not respond to conventional therapies. A multidisciplinary approach to patient management was advocated to ensure comprehensive and effective care. Despite advancements in CRSwNP treatments, a significant subset of patients continues to exhibit symptoms, necessitating personalized treatment approaches. The investigation of clinicopathological features, patient stratification, and the use of biologics are promising strategies for improving outcomes for difficult-to-treat CRSwNP. Further region-specific clinical studies and multicenter collaborations are needed to validate these consensus recommendations, optimize biologic use, and develop tailored treatment algorithms for difficult-to-treat CRSwNP in the GCC region.