What is Chronic Rhinosinusitis?
Chronic rhinosinusitis (CRS) is a serious nasal inflammatory condition that can significantly harm quality of life and daily functioning. Chronic rhinosinusitis, unlike allergic rhinitis, is characterized by chronic inflammation (not infection, like acute rhinosinusitis) affecting tissues high and deep in the nasal passages, including the area where the openings from the sinuses normally ventilate and drain, causing symptoms that persist for 8 to 12 weeks or longer. Patients with chronic rhinosinusitis may suffer from moderate to severe symptoms for 4 to 6 months a year or more, with symptoms that may be year-round and which often persist for many years.
Chronic rhinosinusitis is commonly divided into 2 subgroups: chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis without nasal polyps. Both subgroups suffer from chronic inflammation of the lining of the deep nasal passages and sinuses. Patients with chronic rhinosinusitis with nasal polyps also develop noncancerous polyps on the chronically inflamed surfaces, typically arising from deep crevices or sinus cavities on both sides of the nose. Both subgroups also share the same 4 defining diagnostic symptoms:
- Nasal congestion/obstruction
- Facial pain and pressure
- Rhinorrhea (drainage and postnasal drip)
- Loss of sense of smell and taste
Other common symptoms of the condition may include chronically disrupted sleep (often due to difficulty with breathing), headaches, fatigue, halitosis, mood disorders (depression), and other symptoms.
Current Treatments and Limitations
Many CRS patients try multiple treatments to obtain relief, from homeopathic remedies to over-the-counter and prescription medications, often without getting sufficient results. The current and potential future therapies to treat the inflammation suffered by patients with chronic rhinosinusitis with and without nasal polyps have a number of limitations, including:
- Saline rinses are often recommended and appear to offer some relief, helping to clear particles and debris from areas where normal mucociliary clearance is disrupted by chronic inflammation. They are also time-consuming, sometimes difficult or painful, require water free of pathogens, and are inconvenient
- Traditional steroid nasal sprays and pressurized aerosols are frequently great for allergies, but unfortunately with CRS they often provide only limited relief
- Oral steroids can be very helpful, but their benefits are short-lived, and even short-term use of oral steroids is associated with significant side effects
- Most other currently available medical management approaches, such as leukotriene inhibitors or long courses of antibiotics, are not well studied and probably have varying degrees of efficacy
- Aspirin desensitization or other immunotherapies may be suitable for certain select patients, as determined by an allergy specialist
- Surgery has been shown to help but is costly, has certain risks, and for a significant percentage of patients does not result in a cure. Ongoing use of medication to control symptoms or even repeat surgery is common
- Biologic (monoclonal antibody) treatments are currently being developed and may be costly, difficult to administer, or have negative side effects
- Options for patients who continue to suffer despite trying first-line treatment with regular steroid nasal sprays and saline rinses are limited and potentially costly or higher risk, especially if they prefer not to undergo surgery or have already had surgery
 Orlandi RR, Kingdom TT, Hwang PH, et al. International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(Suppl 1):S22-S209.