Overview of Chronic Rhinosinusitis with Nasal Polyps

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease that remains a major challenge in otolaryngology. This review aims to summarize the current knowledge on CRSwNP and provide an overview of available treatment methods. We conducted a PubMed database search and identified 86 publications relevant to this paper.

CRSwNP is characterized by persistent sinonasal symptoms lasting more than 12 weeks (congestion, rhinorrhea, hyposmia) and bilateral polyps, confirmed by endoscopy or computed tomography showing inflammation. The estimated prevalence of CRSwNP ranges up to 4% in the general population and predominantly affects middle-aged patients. In most cases, CRSwNP is driven by a type 2 inflammatory response. Common comorbidities include asthma and aspirin-exacerbated respiratory disease.

Management follows a stepwise approach, and treatment selection depends on disease severity, previous treatment response, and type 2 biomarkers. Treatment typically begins with saline irrigation and intranasal corticosteroids. Refractory cases may require short courses of systemic steroids, endoscopic sinus surgery (ESS), or biologics (dupilumab, mepolizumab, omalizumab, and tezepelumab) targeting type 2 inflammation.

Future research should focus on improved phenotyping and cost-effectiveness.