G.Z. Piskunov, ENT Department, Russian Medical Academy of Postgraduate Education. Polyposis rhinosinusitis is a chronic inflammatory disease of the mucous membrane of the nasal cavity and paranasal sinuses, characterized by the formation and recurrent growth of polyps, consisting primarily of edematous tissue infiltrated with eosinophils. Approximately 1% of the world's population suffers from polyposis rhinosinusitis. There are no exact statistics. Various nosological forms of diseases of the nose and paranasal sinuses are distinguished, each indicating the presence of polyposis. Otolaryngologists believe that polyps should be removed. Is this correct? What is a polyp? Histologically, a polyp consists of damaged, often metaplastic epithelium, located on a thickened basement membrane. The stroma of the polyp is edematous, contains a small number of glands and vessels, and is virtually devoid of nerve endings. The stroma contains fibroblasts, which form a supporting framework, pseudocysts, and cellular elements. The main cells are eosinophils, lymphocytes (neutrophils), and plasma cells. Biologically active substances are present in polyp tissue: histamine, serotonin, leukotrienes, norepinephrine, kinins, prostaglandins, and all types of immunoglobulins. The involvement of IgE in the development of polyposis has been virtually unproven. Polyposis is absent in patients with atopic rhinitis and atopic bronchial asthma. The pathogenesis of polypous rhinosinusitis is complex, and there is no clearly accepted theory regarding the origin and development of polyps. The main controversy between proponents of endonasal endoscopic and microscopic rhinosinus surgery and proponents of radical surgery lies in the question of surgical treatment of polypous rhinosinusitis. The use of endoscopic rhinosinus surgery initially offered great hope for success in the treatment of polypous rhinosinusitis, but this has proven to be untrue. In some cases, polyposis recurrence stopped after the first endoscopic surgery, while in other cases, patients quickly relapsed. The study of clinical material made it possible to identify a certain pattern in the occurrence of relapse, which served as the basis for developing a new tactic in the treatment of polypous rhinosinusitis. From a practical standpoint, based on modern data on polypous rhinosinusitis, the following forms of polypous rhinosinusitis should be distinguished. 1. Polyposis resulting from impaired aerodynamics in the nasal cavity and paranasal sinuses. 2. Polyposis resulting from chronic purulent inflammation of the mucous membrane of the nasal cavity and paranasal sinuses. 3. Polyposis resulting from fungal infection of the mucous membrane. 4. Polyposis resulting from impaired arachidonic acid metabolism. 5. Polyposis in cystic fibrosis, Kartageier syndrome. Polyposis resulting from impaired aerodynamics: various choanal polyps, polypous hypertrophy of the anterior end of the middle turbinate. Polyposis due to chronic purulent inflammation. The success rate of endoscopic surgery is up to 98%. Polyposis due to fungal infection of the mucosa. Eosinophils play a key role in the pathogenesis of polyposis. Polyposis due to arachidonic acid metabolism disorder (aspirin triad). Cystic fibrosis (congenital familial cystic fibrosis of the pancreas, damage to secretory cells, increased viscosity of secretions). Kartagener syndrome (a genetic disorder with autosomal recessive inheritance): bronchiectasis, polypous rhinosinusitis, situs inversus, male infertility, and mucociliary clearance failure. Conclusion: A practicing physician must correctly determine the type of polypous rhinosinusitis. For the first three types of polypous sinusitis, modern intranasal surgery offers excellent results. In the case of general pathology, any surgical intervention—radical or intranasal—is polliative, and sinusitis requires long-term drug therapy.