#1 Clinical Trials Search in Europe

Chronic rhinosinusitis without nasal polyps – Diagnostics

Go back

Chronic rhinosinusitis without nasal polyps is a long-term inflammation of the sinuses lasting more than 12 weeks, affecting millions of people and significantly impacting daily quality of life through persistent symptoms like congestion, facial pressure, and nasal discharge.

Introduction: Who Should Seek Diagnosis

If you have been experiencing nasal congestion, facial pressure, or drainage that has lasted for more than three months, it may be time to consider getting evaluated for chronic rhinosinusitis without nasal polyps. This condition is more common than many people realize, affecting somewhere between 1% to 5% of the population in the United States.[1][2] The condition is actually more prevalent than the version with nasal polyps, making up roughly 70% of all chronic rhinosinusitis cases.[3]

You should consider seeking diagnostics if you have been dealing with ongoing symptoms that interfere with your daily life. Perhaps you wake up every morning with pressure behind your eyes and constant congestion, or you find that simple tasks like breathing feel like a challenge. These persistent problems can disrupt your sleep, affect your ability to concentrate at work or school, and leave you feeling exhausted throughout the day.[4] The condition does not just cause physical discomfort—it can also significantly decrease your overall quality of life, sometimes even more than conditions like chronic obstructive pulmonary disease or heart failure.[5]

It is especially important to seek medical evaluation if you have other health conditions that might be connected to sinus problems. People with asthma, allergies, immune system disorders, or autoimmune diseases are at higher risk for developing this condition.[1][2] If you have asthma that seems difficult to control, chronic rhinosinusitis could be making it worse. Studies have shown that when someone with asthma also has chronic sinus inflammation, they tend to have poorer asthma control and may need to visit the emergency department more often or use more steroid medications.[4]

Environmental factors can also play a role in who should be tested. If you smoke or are exposed to significant air pollution, you may be more susceptible to developing chronic sinus inflammation.[1] Additionally, if you have had previous sinus surgery or have structural abnormalities in your nose, such as a severely deviated septum, you should pay attention to persistent symptoms and consider getting evaluated.[2]

⚠️ Important
Many people dismiss their sinus symptoms as just a common cold or seasonal allergies. However, if your symptoms have persisted for 12 weeks or longer without complete resolution, this is not a temporary problem. Chronic rhinosinusitis is a distinct medical condition that requires proper diagnosis and treatment. Delaying evaluation can lead to continued suffering and may allow the inflammation to worsen over time.

Diagnostic Methods: How the Condition is Identified

Diagnosing chronic rhinosinusitis without nasal polyps requires both your description of symptoms and objective evidence that can be seen or measured by your doctor. The diagnosis cannot be made based on symptoms alone, even if they have been going on for months.[4] This combination approach helps ensure that the correct condition is identified and that appropriate treatment can be started.

Clinical Symptoms and Medical History

The diagnostic process typically begins with a detailed discussion of your symptoms. To meet the criteria for chronic rhinosinusitis, you need to have experienced at least two out of four cardinal symptoms for a minimum of 12 consecutive weeks.[2][4] These four main symptoms are facial pain or pressure, reduced or lost sense of smell (called hyposmia or anosmia), nasal drainage, and nasal obstruction or blockage.

Your doctor will ask detailed questions about each symptom. For example, they may want to know if your nasal drainage is clear or discolored, whether it drips from the front of your nose or down the back of your throat (postnasal drip), and whether your facial pressure worsens when you bend forward. They will also inquire about other symptoms that commonly occur with this condition, such as headaches, fatigue, cough, fever, bad breath, dental pain, or ear pressure.[2]

Understanding your medical history is equally important. Your doctor will ask about any history of allergies, asthma, previous sinus surgeries, immune system problems, or autoimmune diseases. They will want to know about environmental exposures, including whether you smoke or work in environments with significant air pollution or chemical exposure.[1][2] Information about medications you have tried, including over-the-counter remedies and prescription treatments, helps the doctor understand what has or has not worked for you in the past.

Physical Examination

After discussing your symptoms and history, your doctor will perform a physical examination. The most basic examination is called anterior rhinoscopy, which involves looking into your nostrils using a handheld light and a speculum (a small device that gently opens the nostril wider).[2] This simple examination can reveal some signs of inflammation, such as redness, swelling, or abnormal discharge.

A more detailed examination is nasal endoscopy, which is considered one of the most important diagnostic tools for chronic rhinosinusitis.[2] During this procedure, your doctor uses a thin, flexible tube with a light and camera on the end, called an endoscope, to look inside your nose and sinuses. The endoscope allows the doctor to see much more than would be visible during a basic examination. They can identify signs of inflammation, look for purulent (pus-like) discharge coming from the sinus openings, check for swelling in the middle part of the nose called the middle meatus, and most importantly, determine whether nasal polyps are present or absent.[2] This distinction is crucial because chronic rhinosinusitis without polyps and chronic rhinosinusitis with polyps are treated somewhat differently.

The nasal endoscopy is typically performed in the doctor’s office and takes only a few minutes. Your doctor may spray a numbing medication into your nose beforehand to make the procedure more comfortable. While it may feel strange to have a tube inserted into your nose, the procedure is generally well-tolerated and provides valuable information that cannot be obtained any other way.

Imaging Studies

While symptoms and physical examination provide important information, imaging studies offer an even more complete picture of what is happening inside your sinuses. A computed tomography (CT) scan of the sinuses is the imaging study of choice for confirming the diagnosis of chronic rhinosinusitis.[2][4] Unlike a regular X-ray, which provides only a flat, two-dimensional image, a CT scan creates detailed, three-dimensional images that show all of the sinus cavities and the structures around them.

A CT scan is not needed for every person with sinus symptoms. However, it becomes very important if your initial medical treatment is not working, if your doctor is considering surgery, or if there is concern about complications.[2][4] The scan is typically performed without contrast dye, which means you do not need an injection beforehand. You simply lie on a table while the scanner moves around your head, taking multiple images. The entire process usually takes less than 15 minutes.

In a healthy person, the sinuses appear black on a CT scan because they are filled with air. When someone has chronic rhinosinusitis, the sinuses may appear gray or white because they are filled with thickened mucus or swollen tissue.[6] The CT scan can show which sinuses are affected, how severe the inflammation is, and whether there are any anatomical abnormalities that might be contributing to the problem, such as a deviated septum or other structural issues.[2]

It is worth noting that medical guidelines recommend against ordering more than one CT scan within 90 days for uncomplicated chronic rhinosinusitis, as long as the first scan is of good quality.[4] This helps avoid unnecessary radiation exposure and healthcare costs.

In certain situations, magnetic resonance imaging (MRI) may be ordered instead of or in addition to a CT scan.[2] MRI uses magnetic fields and radio waves rather than X-rays to create images. While MRI is generally not the first choice for evaluating chronic rhinosinusitis, it can be helpful when doctors need to look at soft tissues in more detail or when they are concerned about complications that might affect the brain or eyes.

Laboratory and Culture Tests

Laboratory tests are not routinely needed to diagnose chronic rhinosinusitis without nasal polyps, but they can be useful in certain situations. If your doctor suspects that you have an active infection on top of your chronic inflammation, they may take a sample of mucus or discharge from your nose or sinuses for culture.[2] This sample is sent to a laboratory where technicians try to grow any bacteria that might be present. The culture results can help identify which specific bacteria are involved and which antibiotics would be most effective against them.

Allergy testing may be recommended if your doctor thinks allergies are contributing to your sinus problems.[2] This typically involves either skin testing, where small amounts of various allergens are placed on or just under your skin to see if you react, or blood testing to measure antibodies against specific allergens. Identifying allergies can be important because treating allergies may help improve sinus symptoms.

In some cases, especially when the condition is severe, unusual, or not responding to standard treatment, your doctor might recommend additional specialized tests. These could include tests to check your immune system function, tests to look for autoimmune diseases, or other blood work to rule out conditions that can cause similar symptoms.[2]

Distinguishing From Other Conditions

One of the challenges in diagnosing chronic rhinosinusitis without nasal polyps is that many other conditions can cause similar symptoms. Your doctor needs to consider and rule out other possibilities. For example, migraine headaches can cause facial pain and pressure that feels very similar to sinus pressure.[7] Allergic rhinitis (hay fever) can cause nasal congestion and drainage but without the same degree of sinus inflammation. Dental infections can cause facial pain that mimics sinus pain.

The combination of symptoms, physical examination findings, and imaging studies helps your doctor distinguish chronic rhinosinusitis from these other conditions. In some cases, you may need to see specialists—such as an otolaryngologist (ear, nose, and throat doctor), an allergist, or even a neurologist—to fully sort out what is causing your symptoms.[4]

Diagnostics for Clinical Trial Qualification

If you are considering participating in a clinical trial for chronic rhinosinusitis without nasal polyps, you will typically need to undergo additional diagnostic testing beyond what is required for routine clinical care. Clinical trials use standardized criteria to ensure that all participants truly have the condition being studied and that results can be accurately interpreted.

Confirmation of Diagnosis

To qualify for most clinical trials, you will need documentation that you meet the standard diagnostic criteria for chronic rhinosinusitis without nasal polyps. This means you must have at least two of the four cardinal symptoms for at least 12 weeks, plus objective evidence from either nasal endoscopy or CT imaging.[4][6] The trial coordinator will review your medical records to verify that both symptom and objective criteria are met.

Nasal endoscopy is often required for trial enrollment specifically to confirm that you do not have nasal polyps, since clinical trials typically study either patients with polyps or patients without polyps, but not both together.[2] The endoscopy must show evidence of inflammation—such as redness, swelling, or purulent discharge—without any visible polyps in the nasal passages.

A CT scan performed within a certain timeframe before enrollment (often within the past few months) is usually required. The CT scan must show evidence of inflammation in the sinuses to confirm the diagnosis objectively.[2] Trial protocols specify how recent the CT scan must be and what degree of inflammation must be present for you to qualify.

Symptom Severity Assessment

Clinical trials typically require that participants have symptoms of a certain severity. This is assessed using standardized questionnaires that ask about specific symptoms and how much they bother you. These questionnaires help researchers measure whether the treatment being studied actually improves symptoms compared to a placebo or standard treatment.

You may be asked to rate the severity of symptoms like nasal blockage, facial pain, nasal discharge, and loss of smell on numerical scales. Some trials use visual analog scales, where you mark a point on a line to indicate how bad each symptom is. Others use more detailed scoring systems that ask multiple questions about different aspects of your symptoms and how they affect your daily activities.

Exclusion Criteria Testing

Clinical trials have strict rules about who can and cannot participate. These rules, called inclusion and exclusion criteria, are designed to ensure participant safety and study validity. As part of the screening process, you will undergo various tests to make sure you meet the inclusion criteria and do not meet any exclusion criteria.

Common exclusion criteria include having certain other medical conditions, taking certain medications, having had sinus surgery very recently, or being pregnant. You may need blood tests to check your liver and kidney function, blood counts, and to rule out certain infections. If the trial is studying a medication that affects the immune system, you might need tests to confirm your immune system is functioning adequately.

Some trials exclude people who have certain anatomical abnormalities that might interfere with treatment. For example, if a trial is testing a new topical nasal spray, they might exclude people with very severe septal deviation that would prevent the medication from reaching all areas of the sinuses. These anatomical features would be assessed during your nasal endoscopy or on your CT scan.

Baseline Measurements

Before starting any experimental treatment in a clinical trial, researchers need to establish baseline measurements of your condition. This allows them to track changes over time and determine whether the treatment is effective. Baseline testing typically includes a complete medical history, physical examination, nasal endoscopy, and symptom questionnaires.[1]

Some trials may include specialized tests at baseline, such as measurements of sense of smell using standardized smell identification tests, nasal airflow measurements to objectively assess how congested your nose is, or collection of nasal secretions or tissue samples for laboratory analysis. While these tests go beyond routine clinical care, they provide valuable scientific information about how the condition affects different people and how treatments work.

Throughout the trial, many of these baseline tests will be repeated at scheduled intervals to track your progress. This careful monitoring helps ensure your safety and allows researchers to gather the data needed to determine whether the treatment being studied should be approved for broader use.

Prognosis and Survival Rate

Prognosis

The prognosis for people with chronic rhinosinusitis without nasal polyps varies considerably depending on many factors. While this is a chronic condition without a true cure, most people can achieve good control of their symptoms with appropriate treatment.[4][6] The condition tends to be long-lasting, often affecting people for years or even decades, but it does respond to treatment in the majority of cases.

The impact on quality of life can be significant. Studies have shown that chronic rhinosinusitis can decrease quality of life as much as or more than serious conditions like chronic obstructive pulmonary disease or heart failure.[5] However, when properly managed with medical treatment or surgery when needed, most people experience meaningful improvement in their symptoms and quality of life.

Several factors influence prognosis. People who have other conditions such as asthma, allergies, or immune system problems may find their chronic rhinosinusitis more difficult to control.[1][4] Those who smoke or are exposed to environmental pollutants tend to have worse outcomes. On the other hand, people who adhere to their treatment regimens, including regular use of nasal saline rinses and corticosteroid sprays, generally do better over time.

Serious complications from chronic rhinosinusitis without nasal polyps are extremely rare but can occur, especially if acute infection develops on top of the chronic inflammation. These complications can include infections spreading to the area around the eyes (orbital complications like cellulitis or abscess) or to the brain (intracranial complications like meningitis or brain abscess).[4] Such complications require immediate medical attention but are uncommon when the condition is properly monitored and treated.

Survival rate

Chronic rhinosinusitis without nasal polyps is not a life-threatening condition, and it does not affect survival rate. People with this condition have the same life expectancy as the general population. While the disease can significantly impact daily quality of life through burdensome symptoms, it is not associated with increased mortality.[4]

The main health concerns related to chronic rhinosinusitis involve its effects on other conditions rather than survival itself. For people with asthma, uncontrolled chronic rhinosinusitis can make asthma more difficult to manage, potentially leading to more frequent asthma exacerbations and emergency department visits.[4] For people with cystic fibrosis, sinus inflammation can serve as a reservoir for bacteria that may seed lung infections.[4] However, even in these situations, proper management of the sinus condition helps improve overall health outcomes without affecting survival.

Ongoing Clinical Trials on Chronic rhinosinusitis without nasal polyps

  • Study on the Effects of Itepekimab for Patients with Chronic Rhinosinusitis Without Nasal Polyps

    Not recruiting

    1
    Investigated diseases:
    Investigated drugs:
    Belgium France Italy Poland Portugal Romania +1

  • Study on the Effect of Dupilumab for Patients with Chronic Rhinosinusitis with Nasal Polyps

    Not recruiting

    1 1 1 1
    Investigated diseases:
    Investigated drugs:
    Austria

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC4939221/

https://bestpractice.bmj.com/topics/en-us/15

https://www.aaaai.org/tools-for-the-public/latest-research-summaries/the-journal-of-allergy-and-clinical-immunology-in/2018/chronic

https://www.aafp.org/pubs/afp/issues/2017/1015/p500.html

https://www.e-ceo.org/journal/view.php?number=445

https://www.explorationpub.com/Journals/eaa/Article/100959

https://www.pavolsurda.com/chronic-rhinosinusitis-w-nasal-poly

https://pmc.ncbi.nlm.nih.gov/articles/PMC4939221/

More information about
Chronic rhinosinusitis without nasal polyps:

FAQ

How long does it take to get diagnosed with chronic rhinosinusitis without nasal polyps?

The diagnosis requires that symptoms have been present for at least 12 consecutive weeks, so this is the minimum timeframe before you can be formally diagnosed. However, the actual diagnostic process—including the initial doctor visit, physical examination, and possibly imaging studies—can often be completed within a few weeks once you seek medical attention.

Is a CT scan always necessary to diagnose this condition?

Not always. The diagnosis can be made based on symptoms plus objective findings from nasal endoscopy showing inflammation. However, a CT scan is recommended if initial medical treatment fails, if surgery is being considered, or if there are concerns about complications. It provides the most complete picture of which sinuses are affected and how severe the inflammation is.

What is the difference between acute and chronic sinusitis in terms of diagnosis?

The main difference is duration. Acute sinusitis lasts from 7 to 10 days and typically clears up with simple treatments. Chronic sinusitis lasts more than 12 weeks and involves persistent inflammation that becomes an ongoing cycle difficult to break without medical help. Chronic cases also usually affect multiple sinus cavities, while acute infections might target just one area.

Can I have chronic rhinosinusitis even if I don’t have facial pain?

Yes. To be diagnosed, you need at least two out of four cardinal symptoms, and one of them must be either nasal blockage or nasal discharge. You do not necessarily need to have facial pain or reduced sense of smell, although many people do experience these symptoms. The specific combination of symptoms varies from person to person.

Will I need to see a specialist to get diagnosed?

Not necessarily for the initial diagnosis. Many primary care doctors can diagnose chronic rhinosinusitis based on your symptoms and a basic physical examination. However, if you do not respond to first-line medical therapy, you should be referred to an otolaryngologist (ENT specialist) who can perform nasal endoscopy and recommend more advanced treatments. People with other conditions like severe asthma or suspected immune problems may also benefit from seeing an allergist or immunologist.

🎯 Key takeaways

  • • Chronic rhinosinusitis without nasal polyps is more common than the version with polyps, accounting for about 70% of all chronic rhinosinusitis cases.
  • • Diagnosis requires both symptoms lasting at least 12 weeks AND objective evidence from either nasal endoscopy or CT imaging—symptoms alone are not enough.
  • • The four cardinal symptoms are facial pain/pressure, reduced sense of smell, nasal drainage, and nasal obstruction—you need at least two of these, including either blockage or discharge.
  • • Nasal endoscopy is crucial for distinguishing whether you have polyps or not, which determines your treatment approach.
  • • CT scans show inflammation that cannot be seen with the naked eye and are especially important when medical treatment is not working or surgery is being considered.
  • • Many other conditions can mimic chronic rhinosinusitis, including migraines, allergic rhinitis, and dental infections—careful diagnostic evaluation helps identify the true cause.
  • • Clinical trials require more extensive diagnostic testing than routine care to ensure participants truly have the condition and to accurately measure treatment effects.
  • • While chronic rhinosinusitis significantly impacts quality of life, it does not affect survival rate and most people can achieve good symptom control with proper treatment.

Connected medications: