Nasal polyps, inflammatory outgrowths of nasal-sinus tissue, occur in one to four percent of the U.S. general population.  Nasal polyps are frequently associated with a subgroup of chronic rhinosinusitis labeled chronic rhinosinusitis with nasal polyp (CRSwNP).  Among all patients with CRS only 25-30 percent has CRSwNP.  However, CRSwNP is associated with significant morbidity and decreased quality of life, which makes this disease clinically important to identify, fully evaluate, and target specific treatment.

While men are more likely to be affected than women, currently no specific genetic or environmental factors have been linked to the development of the disorder.  CRSwNP is frequently associated with asthma, allergic rhinitis, and aspirin hypersensitivity.  Additionally, factors such as a defect in the nasal-sinus epithelial cells barrier, increased exposure to and colonizing pathogenic organisms, and/or injunction with dysregulation of the host immune system, are thought to play prominent roles in developing CRSwNP.

CRSwNP commonly affects middle-aged men, with the average age of onset near 40 years old.  Nasal polyps present as bilateral inflammatory outgrowths originating in the sinuses and projecting into the nasal airway.  Patients often experience severe nasal obstruction and loss of smell/taste.  The diagnosis is based on sinus CT scan and nasal endoscopy.  In general, patients with CRSwNP have more severe nasal-sinus symptoms than patients diagnosed with CRS without polyps, and the diagnosis is usually associated with asthma or allergic rhinitis.

Moreover, there is a relatively rare subgroup of patients with CRSwNP and asthma who also develop upper and or lower respiratory tract symptoms following the ingestion of medications that inhibit COX-1 enzyme, such as aspirin or non-steroidal anti-inflammatory drugs.  Those patients have much more severe sinus disease activity and undergo more sinus surgeries than patients with CRSwNP alone.

Both topical corticosteroids and nasal saline irrigations are recommended as initial medical therapies.  Intranasal corticosteroids can decrease nasal polyp size, lessen sino-nasal symptoms, and improve the patient’s quality of life.  Oral corticosteroids can also reduce polyp size and improve symptoms.  Patients with significant sino-nasal disease and/or those who do not respond to medical treatment should be evaluated for sinus surgery.  However, nasal polyps can still reoccur despite sinus surgery, especially in patients with CRSwNP and asthma.  Biologics that have been approved for treatment of eosinophilic asthma are currently under investigation to treat CRSwNP with asthma, and show promising results.  Although quality of life can be seriously impacted by severe CRSwNP, the potential new treatments provide reasonable optimism.

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