Chronic rhinosinusitis & nasal polyps

Doctor Examining CT Scan

Nasal polyps are small inflamed swellings that grow from the lining of the sinuses, as part of a condition called chronic rhinosinusitis.  When the polyps are extensive, they start to fill the nasal cavity, leading to nasal blockage, anosmia (loss of sense of smell) and sometimes nasal discharge.

About 7% of people have chronic rhinosinusitis, although not all of these patients have a tendency to form nasal polyps.  Chronic rhinosinusitis is a complex set of conditions of the sinuses, and our knowledge about how to treat it is advancing all the time.  For this reason, it can be helpful to see a surgeon with specific expertise in treating these conditions.

Many patients with chronic rhinosinusitis also have asthma, as there is a close link between these two conditions.  Thorough management of your sinus condition will also benefit the control of your asthma.  We aim to work closely with your GP or chest physician to optimise the treatment of your sinuses and chest conditions as a team.

The treatment of patients with chronic rhinosinusitis should be based on the most current scientific evidence. A key document that summarises this approach is the EPOS 2020 Guidelines. A wide range of information about sinus conditions is available in the new "EPOS for Patients" booklet.

Diagnosis

Chronic rhinosinusitis is diagnosed using a combination of

  1. Medical history (detailed questions about the patient's symptoms)

  2. Examination with a fine nasal endoscope

  3. Imaging (usually a CT scan)

For more detailed treatment planning and to determine the subtype of chronic rhinosinusitis, it can be helpful to have blood tests and/or biopsies (tissue samples) of nasal polyps if the patient undergoes surgery.

Management of chronic rhinosinusitis

There is a wide range of severity of chronic rhinosinusitis, from very mild symptoms, to severe symptoms that significantly affect quality of life. There are various subtypes of the condition, and patients should be treated according to the type they have.  

It is important to recognise that we cannot cure chronic rhinosinusitis.  The aim of treatment is to shrink or remove nasal polyps, and control the underlying inflammation in the sinuses, so that the symptoms stay at the lowest level possible.

Most patients with chronic rhinosinusitis require some kind of long-term, daily treatment for their sinuses.  This is most often in the form of a nasal spray or drops, as well as saline (salt-water) irrigation.  Courses of specific antibiotics and oral steroid medications can be used to decrease inflammation significantly in the short term.

Endoscopic sinus surgery

If medical treatment alone does not control your symptoms of nasal blockage or discharge, you may benefit from endoscopic sinus surgery (ESS).   This is an operation where any nasal polyps you have are removed, and the sinuses are opened up as widely as possible into the nasal cavity.  This is performed endoscopically (through the nostrils using a camera and fine instruments).

The purpose of endoscopic sinus surgery is to improve your symptoms, but more importantly to remove abnormal sinus lining and improve the access for your medications into the sinuses.  This is the reason that ESS can improve your symptoms in the longer term: it does not remove the need for medication, but enhances the effect of your long-term medications.

Advanced therapies

Our understanding of chronic rhinosinusitis is advancing constantly.  New "biologic" medications that suppress particular immune system pathways are becoming available, with strong evidence for their effectiveness in chronic rhinosinusitis.  Examples include mepolizumab, omalizumab and dupilumab.

 

Patients with more severe chronic rhinosinusitis, especially the forms associated with asthma, may benefit from these novel medications if their symptoms are not well controlled with conventional surgical and medical management.