Following the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) treatment algorithm for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), patients suffering from severe uncontrolled CRSwNP are recommended to receive oral corticosteroids, (revision) sinus surgery, systemic biologicals and/or aspirin treatment after desensitization (ATAD). Given the major differences in indications, outcomes, practical considerations, risks and costs of these key pillars of treatment, there is a growing need to define criteria for each treatment option and list the clinically relevant and major considerations for them. This EUFOREA document therefore provides an expert panel overview of the expected outcomes, specific considerations and (contra)indications of the five major treatment arms of severe uncontrolled CRSwNP: oral corticosteroids, primary and revision sinus surgery, biological treatment and ATAD. This overview of treatment considerations is needed to allow physicians and patients to consider the different options in the context of providing optimal and personalized care for severe uncontrolled CRSwNP. In conclusion, the five major treatment options for severe uncontrolled CRSwNP have intrinsic advantages, specific indications and considerations that are of importance to the patient, the physician and the society. This EUFOREA statement supports the unmet need to define criteria for the indication of every treatment pillar of CRSwNP.

1st Department of Otorhinolaryngology Medical School Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece

Allergy and Respiratory Research Group Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK

Center of Biomedical Research in Respiratory Diseases Barcelona Spain

CICS UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal

Clinical and Experimental Respiratory Immunoallergy Institut d'Investigacions Biomèdiques August Pi 1 Sunyer Barcelona Spain

Clinical Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Leuven Leuven Belgium

Clinical Epidemiology Program The Ottawa Hospital Research Institute Ottawa Ontario Canada

Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy

Department of Clinical Pharmacy and Pharmacology University in Groningen University Medical Center Groningen Groningen Netherlands

Department of General Otorhinolaryngology H and N Surgery Medical University of Graz Graz Austria

Department of Microbiology and Immunology Allergy and Clinical Immunology Research unit KU Leuven Leuven Belgium

Department of Microbiology Immunology and Transplantation KU Leuven Catholic University of Leuven Leuven Belgium

Department of ORL HNS Université de Montréal Montreal Canada

Department of Otolaryngology and Head and Neck Surgery Eastern Virginia Medical School Virginia USA

Department of Otolaryngology Head and Neck Surgery University of North Carolina Chapel Hill North Carolina USA

Department of Otolaryngology Head and Neck Surgery University of Ottawa Ottawa Ontario Canada

Department of Otorhinolaryngology Amsterdam University Medical Centres University of Amsterdam Amsterdam The Netherlands

Department of Otorhinolaryngology Hospital Clinic Barcelona Barcelona Spain

Department of Otorhinolaryngology Universitätsklinikum Düsseldorf Dusseldorf Germany

Department of Otorhinolaryngology University of Barcelona Barcelona Spain

Department of Otorhinolaryngology Upper airways research laboratory Ghent University Ghent Belgium

Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Department of Respiratory Medicine and Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden

Dept of Otorhinolaryngology and Center for Allergy and Environment TUM School of Medicine Klinikum rechts der Isar Technical University of Munich Munich Germany

Division of Allergy and Immunology and Northwestern Sinus Center Northwestern University Feinberg School of Medicine Chicago Illinois USA

Division of Otorhinolaryngology Department of Ophthalmology Otorhinolaryngology Head and Neck Surgery Ribeirao Preto Medical School University of Sao Paulo Brazil

Ear Nose and Throat Department Guys and St Thomas Hospital London UK

Faculty of Medicine and Health Sciences University of Antwerp Antwerp Belgium

FCS UBI Faculty of Health Sciences University of Beira Interior Covilhã Portugal

Institut for Klinisk Medicin Aarhus University Aarhus Denmark

Norfolk and Waveney ENT Service James Paget and Norfolk and Norwich University Hospitals Norfolk UK

Otolaryngology Head and Neck Surgery Rhinology A Gemelli University Hospital Foundation IRCSS Rome Italy

Otolaryngology HNS McGovern Medical School of the University of Texas Health Science Center Houston Texas USA

Otolaryngology HNS Thomas Jefferson University Philadelphia Pennsylvania USA

Personalized Medicine Asthma and Allergy IRCCS Humanitas Research Hospital Rozzano Italy

Rhinology and ENT Research Group Norwich Medical School University of East Anglia Norwich UK

Rhinology and Skull Base Unit ENT Department Hospital Clínic Universitat de Barcelona Barcelona Spain

Rhinology Olfactology Unit Department of Otorhinolaryngology Head and Neck Surgery University Hospital of Geneva Geneva Switzerland

Rhinology Unit and Smell Clinic ENT Department Hospital Clínic FRCB IDIBAPS Universitat de Barcelona CIBERES Barcelona Spain

Royal National Ear Nose and Eastman Dental Hospital London UK

Royal National ENT Hospital London and Division of Immunity and Infection University College London UK

The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members Brussels Belgium

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