Current Allergy and Asthma Reports

, Volume 12, Issue 2, pp 144–153 | Cite as

Role of Medical Therapy in the Management of Nasal Polyps

  • Isam Alobid
  • Joaquim Mullol
Sinusitis (ML Kowalski, Section Editor)


Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nasal and paranasal sinus mucosa that, despite differing hypotheses regarding its cause, remains poorly understood. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, postnasal drip, and facial pain or pressure. Among the objectives of CRSwNP management are to eradicate nasal polyps from nasal and sinusal cavities, eliminate symptoms, and prevent recurrences. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating CRSwNP. Other potential treatments are nasal saline irrigation and antihistamines (in allergic conditions). Endoscopic sinus surgery is recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.


Chronic rhinosinusitis Antibiotics Antihistamines Antibiotics Anti–IL-5 Antileukotrienes Corticosteroids Macrolides Nasal decongestants Nasal douching Omalizumab Nasal polyps Medical therapy Management 



No potential conflicts of interest relevant to this article were reported.


  1. 1.
    Hastan D, Fokkens WJ, Bachert C, et al. Chronic rhinosinusitis in European underestimated disease. A GA2LEN study. Allergy. 2011;66(9):1216–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Fokkens WJ, Lund V, Mullol J, on behalf of the European Position Paper on Rhinosinusitis and Nasal Polyps group. EP3OS 2007: European position paper on rhinosinusitis and nasal polyps 2007. Rhinology. 2007;Suppl 20:1–136.Google Scholar
  3. 3.
    Szczeklik A, Nizankowska E, Duplaga M. Natural history of aspirin-induced asthma. AIANE investigators. European network on aspirin-induced asthma. Eur Respir J. 2000;16:432–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Guilemany JM, Angrill J, Alobid I, Centellas S, Prades E, Roca J, et al. United airways: the impact of chronic rhinosinusitis and nasal polyps in bronchiectasic patient’s quality of life. Allergy. 2009;64:1524–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Alobid I, Benítez P, Bernal-Sprekelsen M, Guilemany JM, Picado C, Mullol J. The impact of asthma and aspirin sensitivity on quality of life of patients with nasal polyposis. Qual Life Res. 2005;14:789–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Alobid I, Benitez P, Bernal-Sprekelsen M, Roca J, Alonso J, Picado C, et al. Nasal polyposis and its impact on quality of life. Comparison between the effects of medical and surgical treatments. Allergy. 2005;125:215–9.Google Scholar
  7. 7.
    Alobid I, Benitez P, Pujols L, et al. Severe nasal polyposis and its impact on quality of life. The effect of a short course of oral steroids followed by long-term intranasal steroid treatment. Rhinology. 2006;44(1):8–13.PubMedGoogle Scholar
  8. 8.
    Alobid I, Bernal-Sprekelsen M, Mullol J. Chronic rhinosinusitis and nasal polyps. The role of generic and specific questionnaires on assessing its impact on patients quality of life. Allergy. 2008;63(10):1267–79.PubMedCrossRefGoogle Scholar
  9. 9.
    Nonaka R, Nonaka M, Takanashi S, Jordana M, Dolovich J. Eosinophil activation in the tissue: synthetic steroid, budesonide, effectively inhibits the survival of eosinophils isolated from peripheral blood but not nasal polyp tissues. J Clin Lab Immunol. 1999;51(1):39–53.PubMedGoogle Scholar
  10. 10.
    Roca-Ferrer J, Mullol J, Lopez E, et al. Effect of topical anti-inflammatory drugs on epithelial cell-induced eosinophil survival and GM-CSF secretion. Eur Respir J. 1997;10:1489–95.PubMedCrossRefGoogle Scholar
  11. 11.
    Pujols L, Mullol J, Pérez M, et al. Expression of the human glucocorticoid receptor a and b isoforms in human respiratory epithelial cells and their regulation by Dexamethasone. Am J Respir Cell Mol Biol. 2001;24:49–57.PubMedGoogle Scholar
  12. 12.
    Schmid M, Gode U, Schafer D, et al. Arachidonic acid metabolism in nasal tissue and peripheral blood cells in aspirin intolerant asthmatics. Acta Otolaryngol. 1999;119:277–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Picado C, Fernandez-Morata JC, Juan M, et al. Cyclooxygenase-2 mRNA is downexpressed in nasal polyps from aspirin-sensitive asthmatics. Am J Respir Crit Care Med. 1999;160:291–6.PubMedGoogle Scholar
  14. 14.
    Guilemany JM, Roca-Ferrer J, Mullol J. Cyclooxygenases and the pathogenesis of chronic rhinosinusitis and nasal polyposis. Curr Allergy Asthma Rep. 2008;8(3):219–26.PubMedCrossRefGoogle Scholar
  15. 15.
    Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. 2004;114 Suppl 6:S155–212.CrossRefGoogle Scholar
  16. 16.
    Mygind N. Advances in the medical treatment of nasal polyps. Allergy. 1999;54:12–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Bachert C, Hörmann K, Mosges R, Rasp G, Riechelmann H, Müller R, et al. An update on the diagnosis and treatment of sinusitis and nasal polyposis. Allergy. 2003;58:176–91.PubMedCrossRefGoogle Scholar
  18. 18.
    Mullol J, Picado C. Treatment of inflammatory disease of the nose. Eur Respir Mon. 2001;10:165–83.Google Scholar
  19. 19.
    Berggren F, Johansson L. Cost effectiveness of nasal budesonide versus surgical treatment for nasal polyps. PharmacoEconomics. 2003;21:351–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Xaubet A, Mullol J, Lopez E, et al. Comparison of the role of nasal polyp and normal nasal mucosal epithelial cells on in vitro eosinophil survival. Mediation by GM-CSF and inhibition by Dexamethasone. Clin Exp Allergy. 1994;24:307–17.PubMedCrossRefGoogle Scholar
  21. 21.
    Mullol J, Xaubet A, Lopez E, et al. Comparative study of the effects of different glucocorticosteroids on eosinophil survival primed by cultured epithelial cell supernatants obtained from nasal mucosa and nasal polyps. Thorax. 1995;50:270–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Mullol J, Lopez E, Roca-Ferrer J, et al. Effects of topical anti-inflammatory drugs on eosinophil survival primed by epithelial cells. Additive effect of glucocorticoids and nedocromil sodium. Clin Exp Allergy. 1997;27:1432–41.PubMedCrossRefGoogle Scholar
  23. 23.
    Mullol J, Roca-Ferrer J, Xaubet A, et al. Inhibition of GM-CSF secretion by topical corticosteroids and nedocromil sodium. A comparison study using nasal polyp epithelial cells. Respir Med. 2000;94:428–31.PubMedCrossRefGoogle Scholar
  24. 24.
    Xaubet A, Mullol J, Roca-Ferrer J, et al. Effect of budesonide and nedocromil sodium on IL-6 and IL-8 release from human nasal mucosa and polyp epithelial cells. Respir Med. 2001;95:408–14.PubMedCrossRefGoogle Scholar
  25. 25.
    Fernandez-Bertolin L, Mullol J, Alobid I, et al. Impact of cell culture methods on the outcomes of the in vitro inflammatory response in nasal polyps. Rhinology. 2011;49(5):562–9.PubMedGoogle Scholar
  26. 26.
    Mygind N, Pedersen CB, Prytz S, et al. Treatment of nasal polyps with intranasal beclomethasone dipropionate aerosol. Clin Allergy. 1975;5:159–64.PubMedCrossRefGoogle Scholar
  27. 27.
    Deuschl H, Drettner B. Nasal polyps treated by beclomethasone nasal aerosol. Rhinology. 1977;15:17–23.PubMedGoogle Scholar
  28. 28.
    Holopainen E, Grahne B, Malmberg H, et al. Budesonide in the treatment of nasal polyposis. Eur J Respir Dis Suppl. 1982;122:221–8.PubMedGoogle Scholar
  29. 29.
    Tos M, Svendstrup F, Arndal H, et al. Efficacy of an aqueous and a powder formulation of nasal budesonide compared in patients with nasal polyps. Am J Rhinol. 1998;12:183–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Vendelo Johansen L, Illum P, Kristensen S, et al. The effect of budesonide (Rhinocort) in the treatment of small and medium-sized nasal polyps. Clin Otolaryngol. 1993;18:524–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Lildholdt T, Rundcrantz H, Lindqvist N. Efficacy of topical corticosteroid powder for nasal polyps: a double-blind, placebo-controlled study of budesonide. Clin Otolaryngol. 1995;20:26–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Holmberg K, Juliusson S, Balder B, et al. Fluticasone propionate aqueous nasal spray in the treatment of nasal polyposis. Ann Allergy Asthma Immunol. 1997;78:270–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Keith P, Nieminen J, Hollingworth K, et al. Efficacy and tolerability of fluticasone propionate nasal drops 400 microgram once daily compared with placebo for the treatment of bilateral polyposis in adults. Clin Exp Allergy. 2000;30:1460–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Penttila M, Poulsen P, Hollingworth K, et al. Dose related efficacy and tolerability of fluticasone propionate nasal drops 400 microg once daily and twice daily in the treatment of bilateral nasal polyposis: a placebo-controlled randomized study in adult patients. Clin Exp Allergy. 2000;30:94–102.PubMedCrossRefGoogle Scholar
  35. 35.
    Lund VJ, Flood J, Sykes AP, et al. Effect of fluticasone in severe polyposis. Arch Otolaryngol Head Neck Surg. 1998;124:513–8.PubMedGoogle Scholar
  36. 36.
    Aukema AAC, Mulder PGH, Fokkens WJ. Treatment of nasal polyposis and chronic rhinosinusitis with fluticasone propionate nasal drops reduces need for sinus surgery. J Allergy Clin Immunol. 2005;115:1017–23.PubMedCrossRefGoogle Scholar
  37. 37.
    Small CB, Hernandez J, Reyes A, et al. Efficacy and safety of mometasone furoate nasal spray in nasal polyposis. J Allergy Clin Immunol. 2005;116:1275–81.PubMedCrossRefGoogle Scholar
  38. 38.
    Stjarne P, Mosges R, Jorissen M, et al. A randomized controlled trial of mometasone furoate nasal spray for the treatment of nasal polyposis. Arch Otolaryngol Head Neck Surg. 2006;132:179–85.PubMedCrossRefGoogle Scholar
  39. 39.
    Stjarne P, Blomgren K, Caye-Thomasen P, et al. The efficacy and safety of once-daily mometasone furoate nasal spray in nasal polyposis: a randomized, double-blind, placebo controlled study. Acta Otolaryngol. 2006;126:606–12.PubMedCrossRefGoogle Scholar
  40. 40.
    Vlckova I, Navrátil P, Kana R, Pavlicek P, Chrbolka P, Djupesland PG. Effective treatment of mild-to-moderate nasal polyposis with fluticasone delivered by a novel device. Rhinology. 2009;47(4):419–26.PubMedGoogle Scholar
  41. 41.
    Hansen FS, Djupesland PG, Fokkens WJ. Preliminary efficacy of fluticasone delivered by a novel device in recalcitrant chronic rhinosinusitis. Rhinology. 2010;48(3):292–9.PubMedGoogle Scholar
  42. 42.
    Beer H, Southern KW, Swift AC. Topical nasal steroids for treating nasal polyposis in people with cystic fibrosis. Cochrane Database Syst Rev 2011;(5):CD008253.Google Scholar
  43. 43.
    Pujols L, Mullol J, Picado C. Importance of glucocorticoid receptors in upper and lower airways. Front Biosci. 2010;15:789–800.PubMedCrossRefGoogle Scholar
  44. 44.
    Pujols L, Fuentes-Prado M, Fernández-Bertolín L, Alobid I, Roca-Ferrer J, Mullol J, et al. Lower sensitivity of nasal polyp fibroblasts to glucocorticoid anti-proliferative effects. Respir Med. 2011;105:218–25.PubMedCrossRefGoogle Scholar
  45. 45.
    Benítez P, Alobid I, de Haro J, et al. A short course of oral prednisone followed by long term intranasal budesonide is an effective treatment for severe nasal polyps. Comparative study of various methods of assessment. Laryngoscope. 2006;116:770–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Hissaria P, Smith W, Wormald PJ, Taylor J, Vadas M, Gillis D, et al. Short course of systemic corticosteroids in sinonasal polyposis: a double-blind, randomized, placebo-controlled trial with evaluation of outcome measures. J Allergy Clin Immunol. 2006;118(1):128–33.PubMedCrossRefGoogle Scholar
  47. 47.
    Van Zele T, Gevaert P, Holtappels G, et al. Oral steroids and doxycycline: two different approaches to treat nasal polyps. J Allergy Clin Immunol. 2010;125(5):1069–76.e4.PubMedCrossRefGoogle Scholar
  48. 48.
    Vaidyanathan S, Barnes M, Williamson P, Hopkinson P, Donnan PT, Lipworth B. Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: a randomized trial. Ann Intern Med. 2011;154(5):293–302.PubMedGoogle Scholar
  49. 49.
    Mullol J, Alobid I. Combined oral and intranasal corticosteroid therapy: an advance in the management of nasal polyposis? Ann Intern Med. 2011;154(5):365–7.PubMedGoogle Scholar
  50. 50.
    Martinez-Devesa P, Patiar S. Oral steroids for nasal polyps. Cochrane Database Syst Rev 2011;(7):CD005232.Google Scholar
  51. 51.
    Becker SS, Rasamny JK, Han JK, et al. Steroid injection for sinonasal polyps: the University of Virginia experience. Am J Rhinol. 2007;21:64–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Shalek P, Petras P, Klement V, Hahn A. Short-term antibiotics treatment in patients with nasal polyps and enterotoxins producing Staphylococcus aureus strains. Eur Arch Otorhinolaryngol. 2009;266:1909–13.CrossRefGoogle Scholar
  53. 53.
    Van Cauwenberge P, Van Zele T, Bachert C. Chronic rhinosinusitis and nasal polyposis: the etiopathogenesis revealed? Verh K Acad Geneeskd Belg. 2008;70:305–22.PubMedGoogle Scholar
  54. 54.
    Ragab SM, Lund VJ, Scadding G. Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. Laryngoscope. 2004;114:923–30.PubMedCrossRefGoogle Scholar
  55. 55.
    Videler WJ, Badia L, Harvery RJ, et al. Lack of efficacy of long-term, low-dose azithromycin in chronic rhinosinusitis: a randomized controlled trial. Allergy. 2011;66(11):1457–68.PubMedCrossRefGoogle Scholar
  56. 56.
    Elbez M, De Pressigny M, Halimi P, et al. Does the use of nasal vasoconstrictor agents change tomodensitometric images of nasosinusal polyposis? Ann Otolaryngol Chir Cervicofac. 1993;110:277–80.PubMedGoogle Scholar
  57. 57.
    Johansson L, Oberg D, Melen I, et al. Do topical nasal decongestants affect polyps? Acta Otolaryngol. 2006;126:288–90.PubMedCrossRefGoogle Scholar
  58. 58.
    Haye R, Aanesen JP, Burtin B, et al. The effect of cetirizine on symptoms and signs of nasal polyposis. J Laryngol Otol. 1998;112:1042–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Ricchetti A, Landis BN, Maffioli A, et al. Effect of anti-fungal nasal lavage with amphotericin B on nasal polyposis. J Laryngol Otol. 2002;116:261–3.PubMedCrossRefGoogle Scholar
  60. 60.
    Weschta M, Rimek D, Formanek M, et al. Topical antifungal treatment of chronic rhinosinusitis with nasal polyps: a randomized, double-blind clinical trial. J Allergy Clin Immunol. 2004;113:1122–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Corradini C, Del Ninno M, Buonomo A, et al. Amphotericin B and lysine acetylsalicylate in the combined treatment of nasal polyposis associated with mycotic infection. J Investig Allergol Clin Immunol. 2006;16:188–93.PubMedGoogle Scholar
  62. 62.
    Ebbens FA, Scadding GK, Badia L, et al. Amphotericin B nasal lavages: not a solution for patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2006;118:1149–56.PubMedCrossRefGoogle Scholar
  63. 63.
    Ebbens FA, Georgalas C, Luiten S, et al. The effect of topical amphotericin B on inflammatory markers in patients with chronic rhinosinusitis: a multicenter randomized controlled study. Laryngoscope. 2009;119(2):401–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Gerlinger I, Fittler A, Fónai F, Patzkó A, Mayer A, Botz L. Postoperative application of amphotericin B nasal spray in chronic rhinosinusitis with nasal polyposis, with a review of the antifungal therapy. Eur Arch Otorhinolaryngol. 2009;266(6):847–55.PubMedCrossRefGoogle Scholar
  65. 65.
    Parnes SM, Chuma AV. Acute effects of antileukotrienes on sinonasal polyposis and sinusitis. Ear Nose Throat J. 2000;79:18–20.PubMedGoogle Scholar
  66. 66.
    Ulualp SO, Sterman BM, Toohill RJ. Antileukotriene therapy for the relief of sinus symptoms in aspirin triad disease. Ear Nose Throat J. 1999;78:604–6.PubMedGoogle Scholar
  67. 67.
    Ragab S, Parikh A, Darby YC, Scadding GK. An open audit of montelukast, a leukotriene receptor antagonist, in nasal polyposis associated with asthma. Clin Exp Allergy. 2001;31:1385–91.PubMedCrossRefGoogle Scholar
  68. 68.
    Mostafa BE, Abdel HH, Mohammed HE, et al. Role of leukotriene inhibitors in the postoperative management of nasal polyps. ORL J Otorhinolaryngol Relat Spec. 2005;67:148.PubMedCrossRefGoogle Scholar
  69. 69.
    Pauli C, Fintelmann R, Klemens C, et al. Polyposis nasi improvement in quality of life by the influence of leukotrien receptor antagonists. Laryngorhinootologie. 2007;86(4):282–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Stewart RA, Ram B, Hamilton G, Weiner J, Kane KJ. Montelukast as an adjunct to oral and inhaled steroid therapy in chronic nasal polyposis. Otolaryngol Head Neck Surg. 2008;139(5):682–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Mullol J, Callejas FB, Méndez-Arancibia E, et al. Montelukast reduces eosinophilic inflammation by inhibiting both epithelial cell cytokine secretion (GM-CSF, IL-6, IL-8) and eosinophil survival. J Biol Reg Homeos Ag. 2010;24(4):403–11.Google Scholar
  72. 72.
    Vuralkan E, Saka C, Akin I, et al. Comparison of montelukast and mometason furoat in the prevention of recurrent nasal polyps. Ther Adv Respir Dis 2012 (in press).Google Scholar
  73. 73.
    Stevenson DD. Aspirin desensitization in patients with AERD. Clin Rev Allergy Immunol. 2003;24:159–68.PubMedCrossRefGoogle Scholar
  74. 74.
    Nucera E, Schiavino D, Milani A, et al. Effects of lysine-acetylsalicylate (LAS) treatment in nasal polyposis: two controlled long term prospective follow up studies. Thorax. 2000;55:75–8.CrossRefGoogle Scholar
  75. 75.
    Scadding GK, Hassab M, Darby YC, et al. Intranasal lysine aspirin in recurrent nasal polyposis. Clin Otolaryngol. 1995;20:561–3.PubMedCrossRefGoogle Scholar
  76. 76.
    Parikh AA, Scadding GK. Intranasal lysine-aspirin in aspirin-sensitive nasal polyposis: a controlled trial. Laryngoscope. 2005;115:1385–90.PubMedCrossRefGoogle Scholar
  77. 77.
    Ogata N, Darby Y, Scadding G. Intranasal lysine-aspirin administration decreases polyp volume in patients with aspirin-intolerant asthma. J Laryngol Otol. 2007;121:1156–60.PubMedCrossRefGoogle Scholar
  78. 78.
    Guglielmo M, Gulotta C, Mancini F, Sacchi M, Tarantini F. Recalcitrant nasal polyposis: achievement of total remission following treatment with omalizumab. J Investig Allergol Clin Immunol. 2009;19(2):158–9.PubMedGoogle Scholar
  79. 79.
    Grundmann SA, Hemfort PB, Luger TA, Brehler R. Anti-IgE (omalizumab): a new therapeutic approach for chronic rhinosinusitis. J Allergy Clin Immunol. 2008;121(1):257–8.PubMedCrossRefGoogle Scholar
  80. 80.
    Penn R, Mikula S. The role of anti-IgE immunoglobulin therapy in nasal polyposis: a pilot study. Am J Rhinol. 2007;21(4):428–32.PubMedCrossRefGoogle Scholar
  81. 81.
    Pinto JM, Mehta N, DiTineo M, Wang J, Baroody FM, Naclerio RM. A randomized, double-blind, placebo-controlled trial of anti-IgE for chronic rhinosinusitis. Rhinology. 2010;48(3):318–24.PubMedGoogle Scholar
  82. 82.
    Vennera MC, Picado C, Mullol J, Alobid I, Bernal-Sprekelsen M. Efficacy of omalizumab in the treatment of nasal polyps. Thorax. 2011;66(9):824–5.CrossRefGoogle Scholar
  83. 83.
    Walsh GM. Reslizumab, a humanized anti-IL-5 mAb for the treatment of eosinophil-mediated inflammatory conditions. Curr Opin Mol Ther. 2009;11(3):329–36.PubMedGoogle Scholar
  84. 84.
    Gevaert P, Lang-Loidolt D, Lackner A, et al. Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps. J Allergy Clin Immunol. 2006;118(5):1133–41.PubMedCrossRefGoogle Scholar
  85. 85.
    Gevaert P, Van Bruaene N, Cattaert T, et al. Mepolizumab, a humanized anti-IL-5 mAb, as a treatment option for severe nasal polyposis. J Allergy Clin Immunol. 2011;128(5):989–95.e1-8.PubMedCrossRefGoogle Scholar
  86. 86.
    Asplund MS, Hagberg H, Holmström M. Chemotherapy in severe nasal polyposis—a possible beneficial effect? A report of three cases. Rhinology. 2010;48(3):374–6.PubMedGoogle Scholar
  87. 87.
    Buyukozturk S, Gelincik A, Aslan I, Aydin S, Colakoglu B, Dal M. Methotrexate: can it be a choice for nasal polyposis in aspirin exacerbated respiratory disease? J Asthma. 2009;46(10):1037–41.PubMedCrossRefGoogle Scholar
  88. 88.
    Freeman SR, Sivayoham ES, Jepson K, de Carpentier J. A preliminary randomised controlled trial evaluating the efficacy of saline douching following endoscopic sinus surgery. Clin Otolaryngol. 2008;33(5):462–5.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clínic i Universitari, IDIBAPSBarcelonaSpain

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