Chronic Rhinosinusitis: What is it, Diagnosis, and Treatment

What is Chronic Rhinosinusitis (CRS)?

Rhinosinusitis occurs when the lining of the sinuses becomes infected, irritated, swollen, and inflamed, leading to extra mucus and challenges with mucus drainage. When this condition lasts for more than 12 weeks despite attempts to treat it, it is considered Chronic Rhinosinusitis or CRS.

CRS may appear abruptly. It can begin as a nonspecific respiratory infection or acute, short-term inflammation of the sinuses that fails to clear up. From there, it may develop slowly, but gradually over months or years. Occasionally, the first sign of CRS may be the unexpected showing of a “danger sign,” like severe headaches, facial pain, or visual changes.

There are several different types of CRS:

CRS without nasal polyps (CRSsNP) is the most common type and is caused by the chronic inflammation of the sinonasal mucosa and paranasal sinuses
CRS with nasal polyps (CRSwNP) occurs when there is CRS plus abnormal growth of tissue inside the nose and sinuses (called nasal polyps) that can clog the sinuses
CRS with fungal allergy occurs when occurs when there is CRS plus a strong allergic response to fungi inside the sinuses, causing thick mucus to fill the sinuses

Symptoms:

Symptoms of CRS may include nasal congestion, mucus discharge from the nose, or mucus that drips down the back of the throat. Other symptoms might be:

facial pain
decreased sense of smell
facial pressure or “fullness

Diagnosis:

To be diagnosed with CRS, there must be at least two of the symptoms listed above present for 12 weeks.

Treatment:

In general, CRS cannot be cured, but symptoms can be managed with various treatments and lifestyle modifications. For instance, people with CRS may be encouraged to stop smoking (if they smoke) and avoid environments that cause allergy flare ups. They may also be prescribed medications like steroids, nasal sprays, and antibiotics. If someone has CRSwNP, they may have surgery to remove the polyps. Another goal for medical therapy may be improved control of respiratory disease.

Additional Information About CRSsNP:

People with CRSsNP tend to make up most of the CRS population. Black and African American patients tend to report hyposmia (reduced smell) as one of their main symptoms.

If you think you or a loved one is being impacted by CRS (either with or without nasal polyps), please seek the advice of a qualified medical professional. Some options include:

Allergists
Rhinology Specialists
Otolaryngologists
Primary Care Doctors

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References

Coren J. Patient education: Chronic rhinosinusitis (Beyond the Basics). UpToDate. Mar 2023. Accessed Sep 18, 2023.
Rank M. and Holbrook E. Chronic rhinosinusitis without nasal polyposis: Management and prognosis. UpToDate. Sep 2023. Accessed Sep 18, 2023.
Cho. S, et al. Chronic Rhinosinusitis Without Nasal Polyps. J Allergy Clin Immunol Pract. 2016; 4(4): 575–582.
Mahdavinia M, et al. African American Patients with Chronic Rhinosinusitis Have a Distinct Phenotype of Polyposis Associated with Increased Asthma Hospitalization . J Allergy Clin Immunol Pract. 2016; 4: 658-664.e1.
Soler Z, et al. Chronic rhinosinusitis, race, and ethnicity Am J Rhinol Allergy. 2012; 26(2): 110-6.
Konsur E, et al. Race and ethnicity define disparate clinical outcomes in chronic rhinosinusitis. Ann Allergy Asthma Immunol. 2022; 129(6): 737-741.
Chronic rhinosinusitis without nasal polyps: clinical characteristics and comorbid diseases. American Academy of Allergy, Asthma, & Immunology. Oct 2018. Accessed Sep 18, 2023.
Gosepath J and Pfaar O. Chronic Rhinosinusitis with and without Nasal Polyps. Ento Key – Fastest Otolaryngology & Ophthalmology Insight Engine. Jun 2020. Accessed Sep 18, 2023.