Chronic rhinosinusitis with nasal polyps (CRSwNP) is a long-lasting medical condition that affects one in seven Americans incurring medical; expenses of up to $5billion per year. The condition is typically triggered by infection or exposure to irritants, such as allergies. Nasal blocking, nasal inflammation, nasaldischarge, odor and taste degradation, and facial discomfort and pressure are signs of chronic rhinosinusitis. Some people suffering from chronic rhinosinusitis also experience secondary symptoms that are aggravated by existing allergies, such as asthma and nasal polyps. A nasal polyp is a non-cancerous tumor that arises from the nose tissue lining or sinuses and impacts the sinus drainage system.

Diagnosis and Treatment of Chronic Sinusitis with Polyps

Managementof nasal polyps usually begins with medications that target the symptoms. For example, your doctor may recommend the use of Nasal corticosteroids such as budesonide (Rhinocort), fluticasone (Flonase Allergy Relief, Flovent HFA, Xhance), triamcinolone (Nasacort Allergy 24HR),mometasone (Nasonex, Asmanex HFA), among others, which may trigger even big polyps to shrink or disappear. Other forms of treatment of chronic sinusitis,such as endoscopic sinus surgery, sinus irrigation, and steroid nasal sprays,may be used to deal with the polyps. However, many people continue to suffer from the symptoms even after treatment. Chronic rhinosinusitis with nasal polyps is commonly diagnosed by a primary care practitioner who may then refer you to an otolaryngologist, or ear, nose, and throat (ENT) doctor, for specialist care. While chronic rhinosinusitis is not a life-threatening illness, it may significantly affect the quality of life, impair work,productivity, and sleep. It may also lead to social and emotional consequences, such as depression and anxiety. 

A doctor would usually be able to make a diagnosis based on your responses to questions regarding your symptoms. Generally, a medical test and a nasal exam may be conducted. With the aid of a simple illuminated instrument, polyps can be visible.

Treatment with Dupixent (dupilumab) 

Recently, the FDA approved Dupixent (dupilumab) as an effective treatment option for people diagnosed with chronic rhinosinusitis. Dupilumab is a monoclonal antibody extracted from humans. It's a form of medication that enlists the body's immune system to help it do its work effectively. It directly inhibits the cytokines IL-4 and IL-13, chemicals that are active in the allergic inflammatory reaction that contributes to symptoms of this chronic condition. This medication is given every other week by injection under the skin tissue. This injection can be given in a doctor's office or self-administered at home. Studies indicate that Dupixent is effective in reducing the size of nasal polyps as well as the associated nasal congestion. Patients involved in the studies indicated an increase in their ability to smell as well as the need to undergo surgery or use oral steroids.

To diagnose chronic rhinosinusitis with nasal polyps, the ENT can administer anasal endoscopy examination and recommend additional tests, such as imaging studies. The ENT will then decide if you are a suitable candidate for dupilumab, based on your tried therapies. It's important to note that Dupilumabis not a cure for chronic rhinosinusitis with nasal polyps. However, in the management of a chronic illness, it is an exciting development that profoundly influences physical and mental well being.

Dupixent may cause severe allergic reactions and complications, such as eye inflammation (conjunctivitis) and corneal inflammation (keratitis). If a patient develops new or deteriorating eye symptoms, such as redness, scratching, irritation, orvisual changes, it's necessary to consult a physician. Furthermore, Dupixent-treated patients should avoid receiving live vaccinations.

Treatment by Surgery

If prescription therapy does not shrink or eradicate nasal polyps. You will require endoscopic surgery to extract polyps and fix issues with your sinuses that render them vulnerable to infection and growth. In this endoscopic procedure, commonly known as Functional Endoscopic Sinus Surgery (FESS), the physician extends a thin conduit through your nostrils with an illuminated magnifying lens or a miniature camera (endoscope) and directs it through the sinus cavities. He or she may also use some tiny instruments to extract polyps and other contaminants that obstruct the passage of fluids from your sinuses.

Your surgeon may widen the holes leading from your sinuses to your nasal passages.Typically, endoscopic surgery is carried out as an out patient operation. You will typically need a corticosteroid nasal spray after surgery to better avoid the nasal polyps' recurrence. In order to facilitate recovery after surgery,the doctor may also recommend using a saltwater (saline) rinse.

In summary, Chronic nasal polyp rhinosinusitis (CRSwNP) is a chronic paranasal sinus inflammatory condition and is synonymous with benign sinonasal mucosalin flammatory outgrowth. Currently, treatment is restricted to therapeutic choice has been limited to corticosteroids (topical or systemic), sinus surgery, or both. However, the Nasal polyps may recur in extreme situations, thus requiring revision surgery. If you notice symptoms of this condition,reach out to your primary physician to begin treatment.

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