What Does CRS with Nasal Polyps Mean?
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nasal passages and paranasal sinuses lasting at least 12 weeks, characterized by the presence of bilateral, endoscopically visible polyps in the middle meatus, along with symptoms of nasal blockage and/or nasal discharge. 1
Diagnostic Criteria
CRSwNP requires both symptomatic and objective confirmation 2:
Symptomatic Requirements (≥12 weeks duration)
At least two symptoms must be present, with one being mandatory: 1
- Nasal blockage/obstruction/congestion (mandatory symptom) OR
- Nasal discharge—anterior or posterior nasal drip (mandatory symptom)
Plus optional symptoms: 1
- Facial pain/pressure
- Reduction or loss of smell
Objective Confirmation
- Bilateral, endoscopically visualized polyps in the middle meatus 1
- The polyps must be pedunculated lesions, not just cobblestoned mucosa 1
- If necessary, examination should be performed following decongestant application 1
Key Distinguishing Features
CRSwNP is distinct from CRS without nasal polyps (CRSsNP), which has the same symptom criteria but no visible polyps in the middle meatus on endoscopic examination 1. This classification is critical because the two conditions have different underlying inflammatory mechanisms and treatment responses 1, 3.
Underlying Disease Mechanism
CRSwNP is predominantly a type 2 inflammation-mediated disease involving the nasal mucosa and paranasal sinuses 3. The condition represents a spectrum of disease that includes polypoid changes in the sinuses and/or middle meatus, but specifically excludes polypoid disease presenting only in the nasal cavity to avoid diagnostic overlap 1.
Clinical Impact
Patients with CRSwNP experience significant disease burden 3:
- High symptom burden including nasal congestion, loss of smell, and rhinorrhea
- Negative impact on physical and mental health-related quality of life
- Sleep quality impairment
- Frequent recurrence even after medical and surgical interventions
Common Comorbidities
Important associated conditions to assess include: 1
- NSAID-exacerbated respiratory disease (N-ERD/aspirin sensitivity)
- Asthma or bronchial hyperreactivity
- Allergic conditions based on specific IgE or skin prick testing
- Elevated total serum IgE levels
These comorbidities are relevant because type 2 inflammation is implicated in multiple coexisting diseases, and patients with these conditions often have more severe disease 3, 4.
Post-Surgical Definition
After sinus surgery has altered the lateral wall anatomy, polyps are defined as bilateral pedunculated lesions (not cobblestoned mucosa) observed more than 6 months after surgery on endoscopic examination 1. Any mucosal disease without overt polyps post-surgery should be classified as CRS without nasal polyps 1.