Unlike those with seasonal allergies, some individuals experience nasal and sinus inflammation year-round, with congestion, painful sinus pressure, frequent bothersome drainage that may be thick or discolored, and reduction or loss of taste and sense of smell.
When such symptoms last longer than eight weeks, the condition is called chronic sinusitus (CS) or chronic rhinosinusitus (CRS). Patients with this condition may experience disturbed sleep or even sleep apnea, difficulty breathing, headaches and pain in the teeth, associated infections, which may spread, chronic cough, fatigue, bad breath, nausea, ear pain and worsening of asthma, all of which can negatively impact quality of life. In addition to the daily burden, evidence suggests that flare-ups may occur on average, three times per year and may require extra visits to the doctor. The symptoms of chronic sinusitis, with or without nasal polyps, are very challenging to resolve.
Chronic Sinusitis with Nasal Polyps
During an infection or allergic reaction, for example, the lining of the nose becomes inflamed, swollen and may produce extra or abnormal fluid. When this inflammation becomes long-term, or chronic, the fluid-producing lining of the nasal cavity and sinuses sometimes forms polyps. Polyps are soft non-cancerous growths filled with inflammatory cells and fluid that may grow large enough to block nasal passages, interfere with breathing, block sense of smell/taste, and lead to frequent infections. Polyps most often arise in the area where the sinuses drain into the nasal cavity, called the osteomeatal complex, and patients may be unaware of their presence until a physician sees the polyps during a nasal examination. Chronic sinusitis, or chronic rhinosinusitis, can occur with or without nasal polyps.
Although polyps can develop in patients with no previous nasal problems, certain factors are associated with their development, including chronic sinusitis, asthma, allergic rhinitis, cystic fibrosis, Churg-Strauss syndrome and NSAID sensitivity, as well as a genetic or inherited pre-disposition. Nasal polyps often return even after surgery or other treatment.
Chronic nasal inflammatory diseases such as chronic sinusitis or chronic rhinosinusitis are diagnoses made by a doctor. Typical symptoms as described above, lasting for at least 8-12 weeks, are the usual basis for the diagnosis. In addition to a general examination, a physician will usually examine the inside of the nose, sometimes by direct visualization and sometimes using a nasal endoscope. Physicians may also request additional testing such as imaging of the nasal cavity and sinuses using a CT or MRI scan or allergy skin testing, to rule-out other causes of symptoms and better characterize the condition. The diagnosis of nasal polyps is usually made after the polyps are observed by the physician on examination or on imaging.