Chronic Rhinosinusitis Together With Nasal Polyps

This is a very common condition affecting around 12% of people all over the world.⁽¹⁾ About 20% of patients suffering from chronic rhinosinusitis also have nasal polyps.⁽²⁾ With these two conditions combined, it is referred to as chronic rhinosinusitis with nasal polyps (CRwNP).

A 2016 research has shown that the age group which commonly gets affected with chronic rhinosinusitis with nasal polyps is around 40 to 60 years old.^{(3, 13)} Another study in 2015 has shown that patients suffering from chronic rhinosinusitis with nasal polyps may also have a history of asthma and allergies.⁽⁴⁾ Another risk factor for this condition is Gastroesophageal Reflux Disease (GERD).

Chronic rhinosinusitis with nasal polyps as the name suggests, combines two conditions which are:

• Chronic rhinosinusitis is a long term chronic irritation of the nasal cavity and sinuses with inflammation lasting for a minimum of 12 weeks.
• Nasal polyps are benign growths of soft tissue within the nose.

Both of these conditions can cause chronic symptoms like: Nasal discharge; congestion; decreased or loss of smell and facial pressure or pain.  Both these conditions commonly develop in conjunction and can make the other worse.

As time goes on, having chronic rhinosinusitis increases the risk of getting nasal polyps. These nasal polyps in turn exacerbate symptoms of rhinosinusitis by blocking the flow of mucus.

A research has shown that around 20% of patients suffering from chronic rhinosinusitis also have nasal polyps.⁽⁵⁾ Patients suffering from asthma or allergies are more susceptible to having both of these conditions.

Sinusitis is nothing but rhinosinusitis, which is inflammation of the nasal passage. Nasal polyps are non-cancerous growths, which develop in the nasal passage and in some cases can also grow into the sinuses.

Acute sinusitis results when a common cold turns into a bacterial infection with symptoms persisting for less than a month. If the symptoms persist for three months even after getting treated, then it can be diagnosed by your doctor as chronic rhinosinusitis.

As mentioned before chronic sinusitis and nasal polyps frequently develop together; however, one can also occur without the other.

Both nasal polyps and sinusitis can have similar symptoms which make it difficult to diagnose and these common symptoms are: Headache, nasal congestion; sinus pressure; nasal discharge; tiredness from lack of sleep due to nasal congestion and tenderness surrounding the cheeks, forehead and nose.^{(6, 7)}

If the sinusitis is associated with a viral, bacterial or a fungal infection, then it is acute sinusitis. This can produce symptoms which are not directly associated with nasal polyps and include: Teeth pain, green or yellow nasal discharge; fever; and bad breath.

It is important to bear in mind that one can suffer from sinus infection along with nasal polyps.

In case of any weird or chronic sinus symptoms, it is important to seek medical attention for the right diagnosis and treatment.

Sinus infection can be caused by nasal polyps because they block flow of mucus between the sinuses and throat. This results in accumulation of mucus in the sinuses leading to growth of germs and infection.

Diagnosis of nasal polyps is done through tests such as: CT scan, nasal endoscopy, and allergy and immune testing. Additional tests may also be done to find out other medical conditions, which are commonly associated with nasal polyps.

The treatment for chronic rhinosinusitis with nasal polyps aims at reducing the inflammation in the nasal passages and sinuses and to alleviate the symptoms. Certain treatments can help decrease the size of nasal polyps which can prevent additional obstruction of the nasal passages.

Some of the treatment options done for chronic rhinosinusitis with nasal polyps are:

Oral steroids can be prescribed for a brief duration for treating acute inflammation in the nasal passages and sinuses.^{(7, 13)}

Nasal steroid sprays can also be prescribed as it targets both nasal polyps and chronic rhinosinusitis and can be safely used for longer duration.^{(7, 13)}

Antibiotics are prescribed if a bacterial sinus infection is diagnosed.⁽⁸⁾ Antibiotics help in reducing the symptoms of acute sinusitis; however, will not have any effect on nasal polyps.

Over-the-counter allergy nasal sprays also help in fighting inflammation and reducing symptoms, such as runny nose and congestion. The use of a saline nasal spray to rinse the nasal passages is also recommended by the doctors.⁽⁷⁾

In case of acute chronic rhinosinusitis with nasal polyps which is not responding to any treatment including steroid therapies, then other treatment options which can be recommended by the doctor are:

Biologics such as omalizumab and Dupilumab are two other asthma and allergy medications approved by the FDA for treatment of chronic rhinosinusitis with nasal polyps.⁽⁷⁾

A review from 2020 reveals that dupilumab helps in decreasing the size of the polyps along with decreasing nasal congestion thus reducing the requirement for surgery.⁽⁹⁾ One more research from 2020 has shown that omalizumab substantially improves the symptoms of chronic rhinosinusitis with nasal polyps and also the quality of life of the patient when compared with a placebo.⁽¹⁰⁾

Leukotriene Modifiers: A review from 2013 shows that Leukotriene Modifiers helps in reducing the symptoms of chronic rhinosinusitis with nasal polyps and also the size of the polyps.⁽¹¹⁾ Montelukast is an allergy medication which specifically helps patients suffering from chronic rhinosinusitis with nasal polyps along with asthma.⁽¹²⁾

In case of severe chronic rhinosinusitis with nasal polyps where medications are not helping and the patient has multiple polyps which are bigger in size, then polypectomy is recommended which is a surgical procedure to remove polyps.

Surgery to remove nasal polyps gives relief from the symptoms; however, there is also a chance of re-growth of the polyps.⁽¹³⁾ Even after the surgery, patient may need to take medications to manage sinus and nasal inflammation associated with allergies.

Chronic rhinosinusitis with nasal polyps is a medical condition comprising of inflammation of the sinus along with growths of the polyps in the nasal passages. With time the polyps can grow in size and worsen the symptoms of rhinosinusitis.

If the symptoms persist despite taking medications then a thorough examination is needed of the sinuses. There are various treatment options available to alleviate the symptoms or to shrink or remove the polyps altogether. However, there is always a chance of re-growth.

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