Chronic Rhinosinusitis With Nasal Polyps

Rhinosinusitis (or sinusitis), more commonly known as a sinus infection, affects 30 million people in the United States each year. When a sinus infection lasts for 12 weeks or longer, it's known as chronic rhinosinusitis.

Nasal polyps, which are small, noncancerous growths in the nose or sinuses, often occur with chronic rhinosinusitis. These conditions occur together because of chronic inflammation in the nasal and sinus membranes.

This article will explore the symptoms, risk factors, diagnosis, and treatment of both chronic rhinosinusitis and nasal polyps, as well as ways to prevent or reduce the frequency of nasal polyps.

Symptoms of Sinusitis

Sinusitis is classified based on how long the infection and symptoms have been present. If the symptoms have occurred for four weeks or less, it's known as acute sinusitis. When symptoms are present for four to 12 weeks, it's known as subacute sinusitis.

However, when sinusitis persists at the 12-week mark and beyond, sinusitis is then called chronic rhinosinusitis.

To be diagnosed with chronic rhinosinusitis, you must have at least two of the following symptoms or findings of the condition on a computed tomography (CT) scan:

• Nasal congestion
• Pain or pressure in the face
• Mucus discharge through the nose or down the throat
• Reduced sense of smell
• Fatigue

If you have taken antibiotics for symptoms of sinusitis but symptoms continue to recur, you may have chronic rhinosinusitis.

Risk Factors and Causes

Why an acute rhinosinusitis infection becomes a chronic rhinosinusitis infection is not fully understood.

However, people who are prone to chronic rhinosinusitis often have one or more of the following risk factors:

• Allergies
• Asthma
• Exposure to smoke or toxins
• Immune system disorders that cause regular infections
• A deviated septum, which occurs when the wall between the nostrils is bent to one side
• Intolerance to aspirin

Risk Factors for Nasal Polyps

Nasal polyps are present in 20% of people with chronic rhinosinusitis. Nasal polyps are believed to be caused by chronic inflammation of the sinuses.

Other risk factors for nasal polyps include:

• History of chronic rhinosinusitis
• Presence of nasal polyps in a first-degree relative
• Persistent asthma
• Aspirin-exacerbated respiratory disease (AERD)
• Cystic fibrosis
• Environmental factors, such as chemicals and cigarette smoke 

Diagnosis and Treatment

When diagnosing chronic rhinosinusitis, a healthcare provider may ask about typical symptoms such as fever, pain (particularly sinus pain), coughing, and nasal congestion.

The healthcare provider may use a handheld device with a lighted end, known as an endoscope, to see inside the nose and determine whether the sinuses are swollen and/or draining. A CT scan may also be needed to diagnose chronic rhinosinusitis.

Diagnosing Nasal Polyps

A healthcare provider will diagnose nasal polyps using similar methods: a physical exam, gathering a medical history, a nasal endoscopy, and a sinus CT scan.

Usually a history of nasal congestion, chronic rhinosinusitis, and loss of smell may suggest nasal polyps.

Viral and Bacterial Sinusitis Treatments

Since most sinusitis infections, especially acute ones, are viral in nature, they typically improve within two weeks.

However, if symptoms do not improve after seven to 10 days and a bacterial infection is suspected, a healthcare provider provider may prescribe antibiotics.

In addition to oral antibiotics, an intranasal corticosteroid may also be prescribed, which in some cases may be more effective than just antibiotics alone.

Treatment for Nasal Polyps

Treatment for nasal polyps may include the following:

• Topical nasal steroid sprays or saline rinses: The most common recommended treatment. They significantly decrease polyp size, increase nasal airflow, and reduce nasal congestion.
• Leukotriene inhibitors: These medications block leukotrienes, inflammatory substances released by the body in response to an allergen. They cause airways to restrict, nasal passages to swell, and an increase in mucus production. Singulair (montelukast) is an example of a leukotriene inhibitor.
• Dupixent (dupilumab): This injectable medication that is typically used to treat asthma has also been approved to treat chronic rhinosinusitis with nasal polyps. Taking it every other week may reduce the need for oral steroids and even surgery.
• Oral steroids: Sometimes oral steroids may help to reduce polyp size along with topical nasal steroids, and they may help restore a sense of smell.
• Surgery: When polyps cause a blockage or obstruction in the sinuses, or when sinusitis is occurring too frequently, surgery to remove the polyps may be recommended. However, they can grow back after surgery.

How to Prevent Nasal Polyps

While the exact cause of nasal polyps is unknown, they often develop in adulthood in people in their 30s and 40s.

A few ways to prevent or reduce the frequency of nasal polyps include:

• Avoiding allergy triggers: Avoiding allergens and airborne triggers that can lead to inflammation may help prevent nasal polyps.
• Allergy and asthma medications: If you have medications for asthma and allergies, taking them regularly may help reduce inflammation in the sinus and nasal passages.
• Saline nasal spray: Using a saline nasal wash with distilled water regularly can help keep sinus and nasal passages clean and reduce the chances of inflammation and infection.
• Humidifiers: These can help moisten the nasal passages and make it easier to breathe.

A Word From Verywell

When the debilitating symptoms of sinusitis continue for over 10 days, you should see your healthcare provider to rule out a bacterial infection. Resting as much as possible will help your body fight the infection. Also consider using saline nasal washes to clear stuffy nasal passages and warm facial compresses to soothe swollen sinuses. And eating some hot chicken soup doesn't hurt.