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Diagnosis and Comorbidities
Patients with CRSwNP may present with symptoms including nasal congestion, rhinorrhea, facial pain, headache, hyposmia, anosmia, sleep disturbance, and fatigue 1,2. Initial assessment of all patients with suspected CRSwNP should include a nasal endoscopy or sinus CT scan to confirm the diagnosis.3,4 Additional studies, such as bloodwork (WBC and IgE) and allergy testing, may be used to rule out other possible causes of the presenting symptoms.3,4 Other disorders that may have a similar presentation to CRSwNP include eosinophilic granulomatosis with polyangiitis, cystic fibrosis, primary ciliary dyskinesia, and rare nasal tumors.3
CRSwNP diagnosis is based on both subjective and objective criteria.4 Diagnostic criteria include sinonasal inflammation lasting ≥12 weeks with nasal polyps and ≥2 of the following symptoms:2
- Nasal obstruction, congestion, or blockage
- Nasal drainage (anterior or posterior)
- Loss or decreased sense of smell
- Facial pressure, facial pain, or a sense of fullness
- Snoring5
Triggers that irritate the nasal passages can provoke CRSwNP symptoms.5 Symptom triggers include tobacco smoke, strong smells, chemicals, allergens, and non-steroidal anti-inflammatory drugs.5
CRSwNP comorbidities that may impact treatment include allergic rhinitis, asthma, aspirin-exacerbated respiratory disease (AERD), and allergic fungal rhinosinusitis.3 Comorbid asthma and AERD have been reported in up to 65% and 26% of patients with CRSwNP, respectively.1
References
- Bachert C, Bhattacharyya N, Desrosiers M, Khan AH. Burden of disease in chronic rhinosinusitis with nasal polyps. J Asthma Allergy. 2021;14:127-134.
- Buccheit K. Patient education: chronic rhinosinusitis (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/chronic-rhinosinusitis-beyond-the-basics
- Buccheit K, Holbrook E. Chronic rhinosinusitis with nasal polyposis: management and prognosis. UpToDate. https://www.uptodate.com/contents/chronic-rhinosinusitis-with-nasal-polyposis-management-and-prognosis
- Orlandi RR, Kingdom TT, Smith TL, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11(3):213-739.
- What is chronic rhinosinusitis with nasal polyposis (CRSwNP)? Allergy and Asthma Network. https://allergyasthmanetwork.org/health-a-z/chronic-rhinosinusitis-with-nasal-polyps-crswnp/
All URLs accessed on 2/13/24.
