Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition of the sinuses characterized by nasal polyps. Nasal polyps are soft, non-cancerous growths in the nasal passages and sinuses. These polyps can cause nasal congestion, difficulty breathing, loss of smell, and frequent sinus infections.
What are the symptoms of CRSwNP?
CRSwNP symptoms often overlap with other sinus conditions but persist despite standard treatments. Common symptoms include:
- Persistent nasal congestion
- Loss or reduced sense of smell and taste
- Facial pressure or pain
- Runny nose and postnasal drip
- Frequent sinus infections
- Difficulty breathing through the nose
What causes CRSwNP?
CRSwNP is driven by chronic inflammation, often linked to type 2 inflammation, a key driver of conditions such as eosinophilic esophagitis, asthma, and atopic dermatitis. Key risk factors include:
- Type 2 Inflammation – Elevated levels of eosinophils and cytokines like IL-4, IL-5, and IL-13 contribute to persistent inflammation.
- Allergic and Non-Allergic Rhinitis – Chronic nasal irritation can lead to polyp development.
- Asthma – Many people who have CRSwNP also have asthma, particularly severe or hard-to-control asthma.
- Aspirin-Exacerbated Respiratory Disease (AERD) – A sensitivity to aspirin and NSAIDs that can worsen sinus inflammation.
- Genetic and Environmental Factors – A family history of CRSwNP and exposure to pollutants or allergens can increase risk.
Who is affected?
Chronic rhinosinusitis with nasal polyps (CRSwNP) mainly affects adults, most often between the ages of 40 and 60. It is seen more often in men, though women can also develop the condition. People with asthma, aspirin-exacerbated respiratory disease (AERD), or allergies are at higher risk, and CRSwNP is closely linked to type 2 inflammation. This type of immune response can also drive other conditions such as eczema, eosinophilic asthma, and eosinophilic esophagitis (EoE). While CRSwNP is common in adults, it is uncommon in children.
How is CRSwNP diagnosed?
CRSwNP is typically diagnosed through a combination of:
- Clinical Evaluation – Symptoms, medical history, and a physical exam.
- Nasal Endoscopy – A small camera inserted into the nose to visualize polyps.
- Imaging (CT Scan) – Helps assess the extent of inflammation and sinus blockage.
- Allergy and Blood Tests – To determine underlying inflammation markers and comorbid conditions.
How is CRSwNP treated?
CRSwNP treatment focuses on reducing inflammation, managing symptoms, and preventing recurrence. Options include:
Medications
- Intranasal Corticosteroids – Reduce inflammation and shrink polyps.
- Biologic Therapies – Targeted treatments such as monoclonal antibodies that block inflammatory pathways. In the United States, the biologics indicated for CRSwNP treatment include:
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- Dupilumab, approved for CRSwNP in people aged 12 and older
- Omalizumab, approved for CRSwNP in people aged 18 and older
- Mepolizumab, approved for CRSwNP in people aged 18 and older
- Tezepelumab, approved for CRSwNP in people aged 12 and older
- Oral Corticosteroids – Used short-term for severe cases
- Saline Nasal Irrigation – Helps clear mucus and reduce inflammation
- Antibiotics – If bacterial infections are present
Surgical Intervention
- Endoscopic Sinus Surgery (ESS) – Minimally invasive removal of nasal polyps and inflamed tissue when medications are insufficient.
Will CRSwNP require ongoing medical care?
Yes. CRSwNP is a chronic condition that requires ongoing clinical care. Follow your doctor’s recommendations for ongoing medical appointments to ensure your CRSwNP is well-managed.
What is the outlook for people with CRSwNP?
CRSwNP is not known to limit life expectancy, however, it can significantly impact daily life. Since CRSwNP is a chronic condition, long-term management is key. People with CRSwNP should:
- Follow prescribed treatments consistently.
- Avoid known triggers, such as allergens or irritants.
- Maintain follow-up visits with an ENT or allergy specialist.
- Consider lifestyle changes, including dietary modifications and air filtration, to reduce inflammation triggers.
CRSwNP often goes underdiagnosed or undertreated. Increased awareness and early intervention can improve outcomes, helping patients regain their sense of smell, breathe easier, and reduce the burden of chronic sinus disease.
If you or a loved one experience persistent sinus issues, consult a healthcare provider for proper evaluation and management.
Medical Reviewer: Michael Wechsler, MD