FAQs

What is CRSwNP and what symptoms may I experience?

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition of the sinuses and nasal passages.¹ Symptoms of CRSwNP include:²^,3

Nasal congestion
Runny nose
Facial pain, facial pressure, or a feeling of “fullness” of the face
Decrease or loss of sense of smell
Headache
Fatigue⁴
Snoring

What are the risk factors for CRSwNP?

Risks factors for developing CRSwNP include asthma and older age.⁵ Nearly two-thirds of patients with CRSwNP also have asthma, and patients with CRSwNP tend to get diagnosed in their 40s and 50s.^4.6 In general, the condition affects more men than women.⁴

What is the difference between CRS and CRSwNP?

Chronic rhinosinusitis (CRS) is inflammation or infection of the sinuses that lasts at least 3 months.⁷Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type of CRS that affects about one-third of CRS patients⁴. People with CRSwNP have CRS and nasal polyps.⁷

What are the usual treatments for CRSwNP?

Commonly used treatments for CRSwNP include:

Nasal irrigation with saline: Daily flushing of the nasal passages with salt water can help remove mucus and relieve symptoms⁸
Intranasal corticosteroids: These medications are applied topically to the nasal passages via a spray or other delivery system to reduce inflammation⁸
Oral corticosteroids: Oral medication to reduce inflammation that can be given for a brief period of time to reduce severe symptoms⁷. OCS should not be taken more often than necessary because they can lead to long-term side effects⁸
Sinus surgery: Functional endoscopic sinus surgery (FESS) is a surgical procedure to remove nasal polyps and open up the sinuses^8,9
Biologic therapies: Medications administered via injection or infusion that reduce inflammation by targeting key molecules involved in the inflammatory pathways of CRSwNP¹⁰

Can CRSwNP be cured?

CRSwNP is rarely cured. However, the disease can be managed with appropriate treatment to reduce symptoms and improve quality of life⁸

Can nasal polyps come back?

One goal of treatment for CRSwNP is to shrink the size of nasal polyps7. Polyps can be removed with surgery, but they may come back⁸

What are biologics?

Biologic therapies are a class of treatments produced from a living source such as cell or microorganism ^10,11. They are usually administered via injection or infusion.¹² The biologic treatments used for CRSwNP contain monoclonal antibodies. Monoclonal antibodies are proteins with a specific target, such as molecules involved in the inflammatory processes of CRSwNP.^2,10 have been FDA-approved for CRSwNP include dupilumab, omalizumab, and mepolizumab^7,11. Additional biologics currently under investigation as potential treatment for CRSwNP include benralizumab, reslizumab, and Tezepelumab.^8,15,16

Do I need surgery for CRSwNP?

If your CRSwNP is not adequately controlled with nasal irrigation and intranasal corticosteroids, your doctor may offer surgery as a treatment option.⁹ The goal of surgery in patients with CRSwNP is to remove nasal polyps and open the sinuses.⁸ However, surgery is not a cure for CRSwNP and you will likely still need treatment after surgery.^8,9 Talk to your doctor to find out whether surgery or other treatment options are best for you.^8,9

What conditions can affect the treatment of CRSwNP?

CRSwNP can occur together with other conditions, such as asthma, allergic rhinitis, aspirin-exacerbated respiratory disease, and sinus infections.^2,8In these cases, treatment can be managed to most effectively control multiple conditions.^2,8

Biologic therapies can treat both asthma and CRSwNP⁸
Allergic rhinitis. Although there are no biologics FDA-approved for allergic rhinitis, patients may notice improvement in symptoms when taking a biologic for another condition, such as CRSwNP¹⁶
The timing of different treatments can be coordinated to achieve maximized effect⁸
Sinus infections. Antibiotics may be needed for acute sinus infections that result from CRSwNP²

How long do I need to be on treatment for CRSwNP?

Patients with CRSwNP typically require long-term treatment to keep symptoms under control and and improve quality of life.⁸

What questions should I ask my physician?

What lifestyle changes can I make to improve my symptoms?
Can you recommend a nasal irrigation kit?
What is the proper technique for delivery of intranasal corticosteroids?
What treatment options are best for me?
Am I a candidate for biologics or surgery?

References

Rank MA, Chu DK, Bognanni A, et al. The Joint Task Force on Practice Parameters GRADE guidelines for the medical management of chronic rhinosinusitis with nasal polyposis. J Allergy Clin Immunol. 2023;151:386‑398.
What is Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)? Allergy and Asthma Network. https://allergyasthmanetwork.org/health-a-z/chronic-rhinosinusitis-with-nasal-polyps-crswnp/
Buccheit, K. Patient education: Chronic rhinosinusitis (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/chronic-rhinosinusitis-beyond-the-basics
Bachert C, Bhattacharyya N, Desrosiers M, Khan AH. Burden of disease in chronic rhinosinusitis with nasal polyps. J Asthma Allergy. 2021;14:127-134
Chen S, Zhou A, Emmanuel B, Thomas K, Guiang H. Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis. Curr Med Res Opin. 2020;36:1897-1911.
Stevens WW, Schleimer RP, Kern RC. Chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract. 2016;4:565-572.
Holbrook E. Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis. UpToDate. https://www.uptodate.com/contents/chronic-rhinosinusitis-clinical-manifestations-pathophysiology-and-diagnosis
Buccheit K, Holbrook E. Chronic rhinosinusitis with nasal polyposis: management and prognosis. UpToDate. https://www.uptodate.com/contents/chronic-rhinosinusitis-with-nasal-polyposis-management-and-prognosis
Ramkumar SP, Lal D, Miglani A. Considerations for shared decision-making in treatment of chronic rhinosinusitis with nasal polyps. Front Allergy. 2023;4:1137907.
Burmester, GR. Overview of biologic agents in the rheumatic diseases. UpToDate. https://www.uptodate.com/contents/overview-of-biologic-agents-in-the-rheumatic-diseases
What are “biologics?” Questions and answers. Food & Drug Administration. https://www.fda.gov/about-fda/center-biologics-evaluation-and-research-cber/what-are-biologics-questions-and-answers
Monoclonal antibodies and their side effects. American Cancer Society. https://www.cancer.org/cancer/managing-cancer/treatment-types/immunotherapy/monoclonal-antibodies.html
Understanding biologic and biosimilar drugs. American Cancer Society Cancer Action Network. https://www.fightcancer.org/policy-resources/understanding-biologic-and-biosimilar-drugs
Kim SD, Cho KS. Treatment strategy of uncontrolled chronic rhinosinusitis with nasal polyps: A review of recent evidence. Int J Mol Sci. 2023;24:5015.
deShazo R, Kemp S. Pharmacotherapy of allergic rhinitis. UpToDate. https://www.uptodate.com/contents/pharmacotherapy-of-allergic-rhinitis
Tai J, Han M, and Hoon Kim T. Therapeutic strategies of biologics in chronic rhinosinusitis: Current options and future targets. Int J Mol Sci. 2022;23:5523.