Chronic Rhinosinusitis with Polyposis: Diagnosis and Treatment

When patients with chronic rhinosinusitis with polyposis (CRSwNP) visit our clinic, a proper diagnosis and evaluation of relevant factors is our first step in the patient care. CRSwNP is suspected in patients with relevant symptomatology and bilateral nasal polyps. Routinely we ask patients to fill out the SNOT-22, an asthma questionnaire with general questions on asthma and the Asthma Control Questionnaire (ACQ). The workup also includes nasal endoscopy, skin prick testing to measure sensitization to aeroallergens, a screening smell test, and peak nasal inspiratory flow (PNIF) to measure nasal resistance and we order a sinus CT scan when the patient has been operated on previously or when there is a discrepancy between symptomatology and findings on ENT examination. Laboratory testing like blood eosinophilia or total IgE, cystic fibrosis diagnostic tests like sweat test or DNA analysis, brush or biopsy to exclude primary ciliary dyskinesia (PCD), and aspirin challenge are only done when indicated. Unless there are indications for complications, the management plan is based primarily on the symptomatology of the patient. If surgery is required, we carefully discuss with the patient the reason(s) for doing surgery in order to reduce symptoms or to improve access to the sinuses for local treatment. We emphasize the chronicity of the disease and the need for the patient to comply to management advice such as rinsing with high-volume saline and local corticosteroid treatment before and especially after surgery.