Nasal Polyps -Why the polyps recur again and again after FESS surgery?

Nasal Polyps are recurring again even i had a FESS surgery.
Medical Care: The management of nasal polyps should be based on the causative factors. Unfortunately, most cases of nasal polyps have an unclear etiology. Even if the patient is allergic, no clinical evidence shows that the management of allergies reduces or eliminates polyps. Because the underlying etiology in most cases is inflammatory, medical management is aimed at nonspecific treatment of this inflammatory disorder.

Oral corticosteroids are the most effective medication for the short-term treatment of nasal polyps, and oral corticosteroids have the best effectiveness in shrinking inflammatory polyps. Intranasal steroid sprays may reduce or retard the growth of small nasal polyps, but they are relatively ineffective in massive nasal polyposis. Antifungal agents have no role in the management of nasal polyposis, but these agents may be useful in cases of allergic fungal sinusitis with polyposis.

Oral corticosteroids: The time-tested medical treatment for obstructing nasal polyps is oral corticosteroids. The nonspecific anti-inflammatory agent quickly and substantially reduces the size of the inflammatory polyps and improves symptoms. Patients whose polyps respond to oral corticosteroids may be re-treated safely 3-4 times a year, especially if they are not candidates for surgery. The mechanism of action of corticosteroids is unclear. One study showed that corticosteroids induce apoptosis in inflammatory cells in human nasal polyps in vitro.
Topical steroids: Intranasal corticosteroid sprays reduce the growth of small intranasal polyps are most effective in the postoperative period to prevent or retard regrowth of the polyps.
Leukotriene inhibitors: Leukotrienes are formed during the breakdown of arachidonic acid by the enzyme 5-lipoxygenase. They are inflammatory mediators and have been implicated in the pathogenesis of asthma, allergic rhinitis, and nasal polyposis. As a result, they have become targets for therapeutic modulation. Early studies of leukotrienes synthesis inhibitors have shown improvements in nasal airflow and reduction in nasal polyps on endoscopy and imaging studies. Benefits appear to be greatest in patients with concomitant allergic rhinitis and eosinophilic infiltration of the nasal polyps on histology.
Other agents: Other agents with a possible role in management of nasal polyposis are macrolides antibiotics, topical diuretic therapy, and intranasal lysine?acetylsalicylic acid.

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