Chronic Rhinosinusitis Without Nasal Polyps
Chronic rhinosinusitis without nasal polyps is a long-lasting inflammation of the sinuses that affects millions of people worldwide, causing persistent congestion, facial pressure, and drainage that can significantly impact daily life and quality of health.
Table of contents
- What Is Chronic Rhinosinusitis Without Nasal Polyps?
- How Common Is This Condition?
- Common Symptoms
- How Is It Diagnosed?
- Factors That Contribute to the Disease
- Impact on Quality of Life
- Treatment Options
- Related Health Conditions
What Is Chronic Rhinosinusitis Without Nasal Polyps?
Chronic rhinosinusitis without nasal polyps (CRSsNP) is an inflammatory disease of the nose and the air-filled spaces around it called the paranasal sinuses. The term “chronic” means that the inflammation lasts for a long time—more than 12 consecutive weeks—without complete resolution of symptoms[1][2].
The condition is characterized by the absence of growths called nasal polyps, which distinguishes it from another form of chronic rhinosinusitis[1]. CRSsNP appears to be a complex condition with various underlying causes rather than a simple blockage problem as was once thought[1].
chronic sinusitis without nasal polyps, CRSsNP
How Common Is This Condition?
Chronic rhinosinusitis without nasal polyps is more common than chronic rhinosinusitis with nasal polyps[1]. CRSsNP accounts for about 70% of all patients with chronic rhinosinusitis[6][12]. In the United States, chronic rhinosinusitis overall affects between 1% and 5% of the population[4][11].
This condition is the second most prevalent chronic health problem in the United States, causing significant healthcare costs due to medical visits, testing, medications, and surgical procedures[5][6]. The direct and indirect healthcare expenses total billions of dollars every year in the United States[4].
Common Symptoms
To be diagnosed with chronic rhinosinusitis without nasal polyps, patients must have at least two of four main symptoms for at least 12 weeks[2][4]:
- Nasal obstruction or blockage—difficulty breathing through the nose
- Nasal discharge—either from the front of the nose or draining down the back of the throat (called postnasal drip)
- Facial pain or pressure—discomfort or fullness in the face
- Decreased sense of smell—reduced ability to smell or complete loss of smell (hyposmia or anosmia)[2][4]
Other symptoms that may occur include fatigue, cough, headache, fever, bad breath, dental pain, and ear pain or pressure[2]. However, these symptoms can overlap with many other conditions, making diagnosis challenging[7].
How Is It Diagnosed?
Diagnosis requires both symptoms and objective evidence of the disease. A healthcare provider will ask about symptoms and perform a physical examination[2][14].
Two main procedures help confirm the diagnosis:
Nasal endoscopy involves inserting a thin, flexible tube with a light and camera into the nose to look inside. This allows the doctor to see evidence of inflammation, abnormal discharge, swelling, or whether polyps are present[2][7].
Computed tomography (CT) scan of the sinuses is an imaging test that provides detailed pictures. In healthy people, the sinuses appear black on a CT scan because they are filled with air. In patients with CRSsNP, the sinuses may appear grey or white because they are filled with mucus or swollen tissue[4][7]. CT imaging is typically recommended when initial medical treatment fails[2].
Additional tests that may be considered include cultures of nasal or sinus samples to identify bacteria, and allergy testing to determine if allergies contribute to the inflammation[2].
Factors That Contribute to the Disease
Chronic rhinosinusitis without nasal polyps is now understood to be primarily an inflammatory disease rather than simply an infectious process[4][11]. Many factors can contribute to its development.
Several diseases and conditions can predispose someone to CRSsNP. These include allergic rhinitis (nasal allergies), asthma, problems with the cells lining the airways, immune system deficiencies, autoimmune diseases, and certain infections[1][2].
Environmental and personal factors also play important roles. Smoking increases risk, as does exposure to environmental pollution[2]. Previous sinus surgery, certain anatomical variations in the nose and sinuses, and the presence of biofilms—organized clusters of bacteria that are difficult to eliminate—can contribute to the disease[1][2].
The tissue changes in CRSsNP include thickening of the basement membrane (a layer of tissue), increased production of mucus-secreting cells called goblet cells, and the presence of certain inflammatory cells and chemical messengers[1].
- Paranasal sinuses
- Nasal cavity
- Maxillary sinuses
- Frontal sinuses
- Ethmoid sinuses
- Sphenoid sinuses
Impact on Quality of Life
The greatest impact of chronic rhinosinusitis without nasal polyps is the reduction in quality of life through continuous troublesome symptoms and periodic worsening of the condition[4][11].
Studies have found that chronic rhinosinusitis can significantly decrease health-related quality of life, particularly in women[5]. The disease affects physical health through symptoms like congestion and facial pressure, but also impacts emotional well-being. It can lead to frequent absences from school or work, decreased productivity, and difficulties with concentration[6].
The condition interferes with simple daily activities. Basic tasks like breathing can feel challenging. Sleep is often disrupted, and patients may feel tired throughout the day[6]. Some patients may experience depression related to the ongoing burden of their symptoms[5].
Treatment Options
Treatment aims to reduce inflammation, improve drainage from the sinuses, clear any infection, and enhance the delivery of medications to affected areas[4].
First-Line Medical Treatments
The initial approach includes two main therapies that can be used without a prescription:
Nasal saline irrigation involves rinsing the nose with salt water using a specially designed squeeze bottle or neti pot. This simple home treatment helps wash away irritants and mucus from the nasal passages. Studies show that saline irrigations improve symptoms in patients with chronic rhinosinusitis[4].
Intranasal corticosteroid sprays are medications sprayed into the nose that help reduce inflammation. Examples include fluticasone, budesonide, and mometasone. Research demonstrates that these sprays improve symptoms in patients with chronic rhinosinusitis[2][4].
Additional Medical Options
If first-line treatments are not sufficient, doctors may consider additional medications:
Oral antibiotics may be prescribed for up to three weeks when there is evidence of an active bacterial infection on top of the chronic inflammation[4][11]. Long-term use of low-dose antibiotics is sometimes recommended for their anti-inflammatory effects rather than their antibacterial properties[10].
Oral corticosteroids are anti-inflammatory pills or shots that may provide short-term improvement, particularly in patients with nasal polyps. However, they can cause serious side effects when used long-term[4][14].
Antihistamines and medications called leukotriene receptor antagonists may be considered, especially in patients who also have allergies[2].
Surgical Treatment
When medical management does not provide adequate relief, functional endoscopic sinus surgery may be recommended. This procedure involves using small instruments and cameras inserted through the nostrils to open up blocked sinus passages and remove diseased tissue. Surgery can be very effective for patients who do not respond to medications[2][4].
Patients who do not respond to first-line medical therapy should be referred to an ear, nose, and throat specialist (otolaryngologist)[4].
Related Health Conditions
Chronic rhinosinusitis without nasal polyps is associated with several other health conditions. Recognizing these connections is important for comprehensive care.
Asthma is one of the most common conditions that occurs alongside CRSsNP. When both conditions are present, the chronic sinus inflammation can make asthma harder to control, leading to more emergency department visits and increased need for systemic corticosteroid medications[4][11].
Patients with cystic fibrosis almost always develop chronic rhinosinusitis. In these patients, the bacteria in the sinuses can serve as a source for lung infections[4][11].
Selected patients with a history suggesting other underlying conditions such as vasculitides (blood vessel inflammation), granulomatous diseases (conditions causing nodules of inflammation), or immunodeficiency (weakened immune system) may benefit from referral to an allergist or lung specialist[4][11].
While serious complications like orbital infections (around the eye) or intracranial infections (inside the skull) are extremely rare in chronic rhinosinusitis, they can occur, particularly when acute infection is superimposed on the chronic condition[4][11].
