CRSwNP

CRSwNP stands for chronic rhinosinusitis with nasal polyps. It is a subset of chronic rhinosinusitis characterized by inflammatory changes of the nasal mucosa and paranasal sinuses accompanied by the growth of nasal polyps. The condition lasts at least 12 weeks and is typically bilateral.

Pathophysiology is often driven by type 2 inflammation, with eosinophilic infiltration and cytokines such as IL-4, IL-5, and IL-13, along with local IgE production. This endotype is commonly associated with asthma and aspirin-exacerbated respiratory disease (AERD). In some populations, non-type 2 inflammatory patterns are more prevalent.

Clinical features include nasal obstruction, nasal discharge, facial pressure, and reduced or lost sense of smell. Endoscopic examination reveals polypoid masses in the nasal cavity, and CT imaging shows sinus opacification and sinus drainage impairment.

Diagnosis relies on patient-reported symptoms persisting for more than 12 weeks plus objective evidence of sinonasal inflammation on endoscopy or CT imaging.

Management typically begins with medical therapy: intranasal corticosteroids and isotonic saline irrigation as first-line measures; short courses of systemic corticosteroids for flares; antibiotics if bacterial infection is suspected. For refractory disease, biologic therapies targeting type 2 inflammation (such as dupilumab, mepolizumab, benralizumab) may be used, and aspirin desensitization can be considered in patients with AERD. Endoscopic sinus surgery may be performed to restore drainage and improve access for topical treatments; recurrence of polyps after surgery is common, necessitating ongoing medical management.

Prognosis and epidemiology: CRSwNP is a chronic condition with variable course and potential impact on quality of life. Prevalence is relatively low but often coexists with asthma and allergic rhinitis.