Chronic Rhinosinusitis (CRS)

CRS is defined as inflammation of the nasal and sinus mucosa lasting >12 weeks, characterized by nasal obstruction, discharge, facial pressure, and decreased smell. It is divided into CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). The condition often coexists with asthma, allergies, or aspirin-exacerbated respiratory disease (AERD).

Symptoms (need ≥2, one of which must be obstruction or discharge)

• Nasal obstruction/congestion
• Rhinorrhea or postnasal drip
• Facial pain/pressure
• Hyposmia/anosmia
• Chronic cough, fatigue, ear pressure

Diagnosis

• Symptoms >12 weeks plus objective evidence:
• Nasal endoscopy showing polyps, mucosal edema, purulent drainage
• CT sinuses demonstrating mucosal thickening, opacification (Lund-Mackay scoring)
• Evaluate for allergic triggers, asthma, immunodeficiency, ciliary disorders
• Labs for eosinophilia, IgE, aspirin sensitivity in select cases

Treatment & Management

Foundational Medical Therapy

• Daily high-volume saline irrigations
• Intranasal corticosteroid sprays or irrigations (budesonide rinses)
• Short courses of oral steroids for severe flares/polyps
• Antibiotics only for suspected bacterial superinfection (culture-guided)
• Antihistamines, leukotriene modifiers if allergic component
• Treat comorbidities (GERD, AERD, asthma)

Advanced Therapies

• Biologics for CRSwNP (dupilumab, mepolizumab, omalizumab) in patients with recurrent polyps after surgery or who are steroid-dependent
• Short-term macrolides or doxycycline for anti-inflammatory effect (CRSsNP)
• Aspirin desensitization for AERD
• Allergen immunotherapy for IgE-mediated disease

Surgery

• Endoscopic sinus surgery (ESS) when medical therapy fails to restore sinus drainage and reduce polyp burden
• Postoperative maintenance with irrigations and topical steroids remains essential

Living with CRS

• Track symptoms, smell, medication use, irrigations, allergy exposures
• Use humidifiers, avoid irritants (smoke, pollutants)
• Manage sleep apnea or asthma to reduce sinus burden
• Mental health support; chronic congestion impairs quality of life

Complications

• Recurrent acute bacterial infections
• Orbital cellulitis/abscess, meningitis (rare)
• Chronic cough, asthma exacerbations, sleep disturbances

Research & Future Directions

Areas include precision endotyping (type 2 inflammation vs neutrophilic), microbiome modulation, and improved drug delivery devices.

Experimental & Emerging Treatments

• Localized Drug-Eluting Stents: Steroid-eluting implants maintain sinus patency post-surgery.
• Epithelial Barrier Therapies: Agents targeting TSLP, IL-33 to prevent inflammatory cascades.
• Microbiome-Based Rinses: Probiotic sinus irrigations aim to rebalance nasal flora.
• Digital Symptom Tracking: Wearable/environmental sensors help predict flares related to humidity, allergens, or pollutants.

Track CRS with Diagnoza.care

Breathe Freely with Structure – Log nasal symptoms, Smell scores, irrigations, medications, steroids, biologic injections, CT/endoscopy findings, and ENT/allergy/asthma visits; capture side effects; and let the AI companion remind you of maintenance therapy to prevent polyp regrowth.

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Medical Disclaimer: Informational only. Follow your ENT/allergist for individualized evaluation, medical therapy optimization, and surgical/biologic decisions. Sources: European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), American Academy of Otolaryngology–Head and Neck Surgery, American Academy of Allergy Asthma & Immunology