Introduction: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is often treated with endoscopic sinus surgery (ESS); however, patients may require revision surgery due to recurrence. To date, no studies have compared outcomes for combined surgery and biologic therapy for CRSwNP compared with biologic therapy alone.Methods: Retrospective case–control study of CRSwNP patients who underwent ESS while on dupilumab or mepolizumab (ESS‐biologic cohort) compared with CRSwNP patients on biologic therapy (biologic‐only controls). Cohorts were matched according to indication, aspirin‐exacerbated respiratory disease (AERD), sinonasal outcome test‐22 (SNOT‐22), and total polyp scores.Results: Sixteen patients underwent ESS while on biologic therapy (13 dupilumab and 3 mepolizumab). Sixteen patients were biologic‐only controls. There were no significant differences between indication, baseline SNOT‐22 scores, polyp scores, and AERD status between cohorts. Patients underwent surgery a median of 33 days after starting biologic therapy. After 12 months of follow‐up, the total polyp score for the ESS‐biologic cohort decreased from 4.73 to 0.09 compared with a decrease from 5.22 to 3.38 for the biologic‐only controls (95% confidence interval [CI] of difference: −5.37 to −1.38, Cohen's d: 2.40, p = 0.005). In the ESS‐dupilumab subanalysis, the ESS‐dupilumab cohort had a significant reduction in polyp burden from 4.85 to 0.00 compared with 4.88 to 3.50 for the controls (95% CI of difference: −5.68 to −1.32, Cohen's d: −1.69, p = 0.009).Conclusion: In CRSwNP patients, combined ESS and biologic therapy results in a significant and sustained decrease in polyp burden compared with biologic therapy alone. Larger studies are warranted to further examine the impact of combined therapy.

Background: Olfactory dysfunction (OD) affects many survivors of COVID‐19. Prior studies have investigated the use of platelet‐rich plasma (PRP) injections for OD. We describe the first randomized controlled trial investigating topical PRP for OD treatment and contribute to existing literature illustrating PRP as an emerging therapeutic.Methods: This is a single‐blinded, randomized controlled trial conducted from July 2022 to December 2023. Adult patients with OD ≥6 months secondary to COVID‐19 with Brief Smell Identification Test (BSIT) scores of ≤8/12 or SCENTinel odor intensity of ≤40/100 were included. Patients were randomized to three, monthly PRP or placebo‐impregnated Surgifoam treatments into bilateral olfactory clefts. The BSIT, SCENTinel, and Questionnaire of Olfactory Disorders—Negative Statements (QOD‐NS) were completed monthly through month 12.Results: Of 104 patients screened, 83 participated. No significant differences in age, OD duration, BSIT, SCENTinel, or QOD‐NS scores were found between PRP (n = 42) and placebo (n = 41) patients at baseline. PRP patients experienced a statistically significant increase in BSIT scores from baseline at months 5‒9, 11, and 12, while placebo patients did not (p < 0.05). However, total BSIT scores were similar between the two groups throughout the study. Neither the SCENTinel odor intensity scores nor the change from baseline were significantly different between the treatment groups. At month 12, PRP patients experienced minor improvement in OD‐related quality‐of‐life compared with placebo.Conclusions: This study is the first to describe topical PRP as a safe, experimental treatment for OD in humans. PRP may impact odor identification in post‐COVID‐19 OD patients, although the lack of difference in total BSIT scores highlights the need for further study.

Key points: This study examines the impact of dupilumab on medication use for chronic rhinosinusitis with nasal polyposis (CRSwNP) and asthma patients. Patients on dupilumab had a reduction in oral/inhaled/topical steroids, antibiotics, and leukotriene receptor antagonists (LTRAs). The reduction in medication use had no impact on total polyp or SNOT‐22 scores.