Chronic rhinosinusitis with nasal polyposis can be an aggressively recalcitrant disease even in the hands of experienced otolaryngologists. Clinical variants such as aspirin exacerbated respiratory disease and eosinophilic CRS are particularly challenging to manage. With a better understanding of the disease process and postoperative care, endoscopic sinus surgery and extended procedures have lead to improved success rates in the management of severe disease. The aim of this symposium is to discuss when and what to do in challenging cases of CRSWNP, as well as how to do it.