What is Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)?
Chronic rhinosinusitis with nasal polyps (CRSwNP) is long-term inflammation (swelling) in the nose and sinuses. This inflammation leads to soft, noncancerous jelly-like growths called nasal polyps. They feel like a peeled grape and can be as big as a pea.
Sinuses are small, air-filled spaces behind the forehead, cheeks, eyes, and nose. They make mucus to keep the nose moist. And they trap germs, dust, and irritants before they reach your lungs.
At a Glance: Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)
The polyps may be painless, but they can make daily life harder.
- Common symptoms include a stuffy nose, loss of smell, pressure in your face, fatigue, chronic mouth breathing, and trouble breathing through your nose.
- Many people with CRSwNP also have asthma or allergies.
- Treatments include nasal sprays, medicines, biologics (shots), and sometimes surgery. Nose rinses with salt water are also effective.
- CRSwNP is a long-term condition, but with the right care, many people feel much better and can do the things they want to do.
What is Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)
Let’s break down each word to help you better understand CRSwNP:
Chronic rhinosinusitis is a swelling in the nose and sinuses that lasts a long time.
- Chronic: symptoms last for 12 weeks or more.
- Rhino: means nose or nasal cavity.
- Sinus: air-filled spaces inside the bones of your face and head.
- -itis: when you see this at the end of a word, it means inflammation or swelling.
So, rhinosinusitis means swelling in both the nose and the sinuses.
You may hear the condition referred to as “chronic sinusitis” and it may be easier for you to explain your symptoms as “sinusitis” to family, friends and co-workers. But “chronic rhinosinusitis” (CRS) is the accurate term for your condition. The lining of your nose and sinuses are connected, so when swelling happens, it usually affects both.
Nasal polyps (also called nasal polyposis) are soft, jelly-like growths inside the nose and sinuses.
- They are small noncancerous growths that line the nasal passages and sinuses.
- Nasal polyps are painless, but they can cause nasal obstruction. This means they can block airflow and your sense of smell. Nasal polyps can cause symptoms that make daily life harder.
- About 1 to 4 out of every 100 people in the U.S. have nasal polyps.
When the two conditions are combined, it is called chronic rhinosinusitis with nasal polyps (CRSwNP). About 5-12 out of every 100 people worldwide have chronic rhinosinusitis. Of those people, about 25-30 out of every 100 also have nasal polyps.
Acute vs. chronic sinusitis
Doctors often talk about “acute” and “chronic” sinusitis to describe how long sinus problems last.
- Acute sinusitis: a short-term sinus infection that usually lasts 4 weeks or less. It is often caused by a cold or virus.
- Chronic rhinosinusitis: symptoms last 12 weeks or more. It is usually caused by ongoing inflammation (swelling), not just an infection.
CRSwNP often involves Type 2 inflammation, an immune response in the body that often leads to severe symptoms. If your symptoms last more than 12 weeks, you keep losing your sense of smell, or you need repeated oral corticosteroid bursts, talk to your doctor. They may send you to a specialist like an allergist or an ENT (ear, nose, and throat doctor).
How Does Type 2 Inflammation Affect CRSwNP?
Type 2 inflammation helps explain why some people get CRSwNP. It is a specific kind of immune response (how your body fights germs) that becomes overactive in the nose and sinuses. When this happens, the tissues stay swollen, make too much mucus, and begin to form nasal polyps.
Type 2 inflammation happens because of chemical messengers in your immune system called interleukins. Interleukins are signals that tell immune cells when to turn inflammation on or off. In CRSwNP, these signals stay “on” for too long. This keeps swelling active in the nose and sinuses and allows nasal polyps to grow.
Because of this ongoing inflammation, people with CRSwNP often experience:
- Long-lasting swelling in the nose and sinuses
- Thicker mucus
- Growth of nasal polyps
This same type of inflammation also happens in severe asthma, allergies, and eczema. This is why these conditions often occur together.
What is IgE? IgE is a type of antibody (a protein your immune system makes) that your body creates during allergic reactions. In CRSwNP, higher IgE levels can impact disease severity by increasing the swelling in the nose and sinuses. This can help nasal polyps grow.
Symptoms of Chronic Rhinosinusitis with Nasal Polyps
People with chronic rhinosinusitis with nasal polyps (CRSwNP) may have:
- Facial pressure or pain in the upper teeth
- Decreased or lost sense of smell (hyposmia or anosmia)
- Stuffy or blocked nose
- Runny nose with thick mucus
- Breathing through the mouth
- Bad breath (sinus breath, or a “sour smell” to breath)
- Sore throat
- Postnasal drip (mucus flowing into the back of the throat)
- Headaches
- Fatigue
- Difficulty sleeping
- Snoring
People often describe these sinus symptoms as constant, frustrating, and hard to ignore. Many say that loss of smell and ongoing nasal congestion are the symptoms that affect them the most.
People with chronic rhinosinusitis without nasal polyps may have the same symptoms. But CRSwNP is linked with more severe symptoms.
How CRSwNP symptoms affect daily life
CRSwNP symptoms can affect more than just breathing. They can impact quality of life, like how you feel and function each day. Many people report:
- Trouble sleeping because of congestion
- Feeling tired during the day
- Trouble tasting or enjoying food
- Difficulty focusing at work or school
- Feeling frustrated, irritable, or sad
These problems can build up over time and make daily activities harder.
What can make symptoms worse?
Symptoms can flare (get worse quickly) when something irritates the nose or sinuses. This irritation causes the polyps to swell, which makes congestion and pressure worse. Common triggers include:
- Tobacco smoke
- Chemicals or strong smells
- Allergens such as pollens, mold, or dust
- Dry air
- Aspirin or other NSAIDs (nonsteroidal anti-inflammatory drugs, like ibuprofen)
Red-flag symptoms: when to seek urgent care
Most CRSwNP symptoms are not dangerous. Call your healthcare provider or seek urgent care if you notice:
- High fever that does not get better
- Swelling or redness around the eyes
- Blurry or double vision
- Severe headache or swelling on the forehead
- Stiff neck
- Confusion or trouble staying awake
These may be signs of a serious infection that needs treatment right away.
How Common is CRSwNP?
Sinus problems are very common. Nearly 30 million adults in the United States have acute sinusitis, which is a short-term sinus infection that lasts 4 weeks or less.
Chronic sinusitis is less common but still affects many people. Worldwide, 5 to 12 out of every 100 people live with chronic sinusitis. These symptoms last 12 weeks or more and may include facial pressure, congestion, and a runny nose.
Among people with chronic sinusitis, about 25 to 30 out of every 100 also have nasal polyps. When both happen together, it is called chronic rhinosinusitis with nasal polyps (CRSwNP).
Who is most affected by CRSwNP?
Studies show that women may have more severe sinus disease even though fewer are diagnosed with the condition than men.
CRSwNP is often diagnosed in adults between 50 and 60 years old.
It is more common in men (62 out of 100) than in women (38 out of 100).
What Causes CRSwNP?
The exact cause of CRSwNP is unknown. But several factors may increase the chance of getting the condition.
To understand what may be happening in your body with CRSwNP, it helps to know how healthy sinuses work. Your sinuses are air-filled spaces in the bones of your face. There are four pairs of sinuses in your face: the sphenoid, maxillary, frontal, and ethmoid sinuses.
The inside of your nose and sinuses is covered by a thin layer of mucus and a protective lining called the mucosal barrier. This barrier helps keep out germs, allergens, and irritants.
In people with CRSwNP, this mucosal (protective) barrier does not work as well. When the barrier breaks down, it can result in:
- More germs and irritants (like dust, smoke, and allergens) enter the tissue.
- The immune system reacts strongly.
- Long-term inflammation develops.
- The sinus lining becomes swollen and starts to change shape (called tissue remodeling).
- Nasal polyps can form.
The role of bacteria and fungi in sinusitis
Some germs can make the protective barrier even weaker. One of the most common is Staphylococcus aureus.
- One study found 63 out of 100 people with CRSwNP have Staphylococcus aureus in their nasal passages.
- Among people who have CRSwNP, asthma, and aspirin-exacerbated respiratory disease (AERD) together, close to 90 out of 100 have Staphylococcus aureus.
These germs may contribute to the ongoing inflammation seen in CRSwNP.
In addition, people with CRSwNP may overreact to fungi (like mold) that are in the air we all breathe.
- This overreaction causes more swelling and very thick, sticky mucus.
- It is the reason why standard antibiotics often don’t work. The problem is the immune response, not just a simple infection.
Factors that Increase the Risk of CRSwNP
CRSwNP often happens along with other health conditions that affect the airways and immune system. Health conditions that happen together in the same person are called comorbidities.
Some comorbidities can increase the risk of developing CRSwNP, while others can make symptoms more severe or harder to control. Common conditions linked with CRSwNP include:
- Asthma
- AERD (aspirin-exacerbated respiratory disease), also called Samter’s Triad
- Gastroesophageal reflux disease (GERD), when stomach acid flows back up into the throat
- Environmental or seasonal allergies
- Certain immune deficiencies (when the immune system doesn’t work as well as it should)
Doctors also can identify what makes a person more likely to develop CRSwNP. These risk factors include:
- A weakened or damaged sinus barrier
- Long-term type 2 inflammation
- Frequent sinus infections
- A family history of sinus disease or nasal polyps
All of these factors can increase swelling in the nose and sinuses. Over time, this inflammation may lead to polyp growth or make symptoms harder to control.
Are CRSwNP and asthma related?
Yes. CRSwNP and asthma are strongly linked and often occur together. Studies suggest that up to 67 out of 100 people with CRSwNP also have asthma, and people with CRSwNP are more likely to have asthma than those with chronic rhinosinusitis without nasal polyps (CRSsNP).
Research also shows how closely the upper airways (nose and sinuses) and lower airways (lungs and breathing tubes) are connected. About 88 out of 100 people with asthma show signs of sinus inflammation on imaging tests (like a CT scan) even if they do not always have obvious sinus symptoms. This means that inflammation in the nose and sinuses is very common in people with asthma and may play a role in how well asthma is controlled.
Both conditions are driven by similar type 2 inflammation, including:
- Higher levels of eosinophils (a type of white blood cell that causes airway swelling)
- Higher levels of immunoglobulin E (IgE), an antibody linked to allergic inflammation
Because of this shared inflammation, people who have both asthma and CRSwNP often have more severe and harder-to-control symptoms. Treating CRSwNP can improve asthma control and reduce flare-ups.
How CRSwNP affects asthma
Inflammation in the nose and sinuses can affect the lower airways. Nasal polyps and ongoing sinus inflammation may lead to:
- Increased coughing
- Wheezing
- Trouble breathing, especially through the nose
- Nighttime symptoms
- More frequent asthma flare-ups
When sinus inflammation is treated, asthma patients often see their symptoms improve as well.
Signs your asthma may be linked to CRSwNP
Some signs that asthma and CRSwNP may be connected include:
- Loss of smell along with chest tightness
- Frequent need for a rescue inhaler
- Postnasal drip that triggers coughing
- Repeated steroid use for both asthma and sinus symptoms
If you notice these patterns, talk with your care team about whether CRSwNP may be affecting your asthma.
Aspirin-exacerbated respiratory disease (AERD)
Aspirin-exacerbated respiratory disease (AERD), also known as Samter’s Triad, affects about 1 in 10 people with nasal polyps. People with AERD have asthma and develop breathing or sinus symptoms after taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).
People with AERD have:
- Asthma
- Nasal polyps
- Sensitivity to NSAIDs
People with AERD often have:
- More severe sinus disease
- Faster regrowth of nasal polyps
- A higher chance of needing sinus surgery
Treatment considerations for AERD
People with AERD often benefit from care by both an allergist and an ENT specialist. Treatment usually includes standard therapies for CRSwNP and asthma. People with AERD should avoid NSAIDs unless their specialist advises otherwise.
Some people with AERD may be candidates for aspirin desensitization. This is a treatment performed in a medical setting, where small, gradually increasing doses of aspirin are given under close supervision. Over time, this can help the body tolerate aspirin safely.
For some patients, aspirin desensitization may:
- Reduce sinus and asthma symptoms
- Slow nasal polyp regrowth
- Reduce the need for repeated surgery or steroid treatments
- Improve quality of life
Aspirin desensitization requires ongoing treatment. It also involves regular follow-up with an allergist. Your care team can help determine whether this approach is right for you.
Other conditions that often occur with CRSwNP
People with CRSwNP often have other health conditions that affect breathing and inflammation. These conditions can make symptoms harder to control if they are not treated.
Other conditions commonly seen with CRSwNP include:
Frequent sinus infections: These can increase inflammation and slow healing over time.
GERD: When stomach acid flows back up into the throat, it may worsen throat and airway irritation and is more common in people with CRSwNP.
Sleep apnea: Ongoing nasal blockage can make breathing during sleep harder, leading to poor sleep and daytime fatigue.
What Can Trigger CRSwNP?
A trigger is anything that makes CRSwNP symptoms worse. Triggers can cause more swelling in the nose and sinuses. This leads to more congestion, pressure, and trouble breathing.
Your triggers are important to know because each person may react to different things. Learning what affects you can help you manage your symptoms.
Viral infections
Colds and viral infections are one of the most common triggers. When you get sick:
- Inflammation increases
- Mucus becomes thicker
- Symptoms can last for weeks even after the infection is gone
Viral infections are often the reason CRSwNP suddenly “flares up.”
Indoor environment triggers
Indoor air can play a big role in sinus symptoms. Poor indoor air quality (polluted or stale air inside buildings) may increase inflammation. Common indoor triggers include:
- Dust mites
- Mold or mildew
- Pet dander
- Dry indoor air
- Poor ventilation
- Indoor air pollution from cooking or cleaning products
Keeping indoor air clean and at a healthy humidity level can help reduce flares.
Irritants and strong smells
Things in the air can irritate the nose and sinuses, causing polyps to swell. These include:
- Tobacco smoke, secondhand smoke, or incense
- Strong smells, such as perfumes, air fresheners, cleaning sprays, or fumes
- Outdoor air pollution
- Sudden temperature changes (like cold winter air)
Allergens
If you have allergies, certain allergens may worsen CRSwNP symptoms. Common allergens include:
- Pollens
- Dust
- Mold
- Pet dander
Allergens can cause extra swelling that makes breathing harder.
Medicines that can trigger symptoms
Some people react to certain pain relievers. This is especially true for people with AERD.
Possible triggers include:
- Aspirin
- Ibuprofen
- Naproxen
- Other NSAIDs
If you think you may react to these medicines, talk to your doctor before taking them.
How is Chronic Rhinosinusitis with Nasal Polyps Diagnosed?
CRSwNP can be hard to diagnose because its symptoms often overlap with other nasal conditions, most commonly rhinitis.
People with allergic rhinitis (also called hay fever) have nasal symptoms caused by allergens like pollen or dust. People with nonallergic rhinitis have similar symptoms but without a clear trigger. Because these conditions share many symptoms, it is important to see a board-certified allergist or an ENT doctor for the correct diagnosis.
Doctors diagnose CRSwNP by asking about your symptoms. They look at the inside of your nose and sinuses. Since CRSwNP is a long-term condition, getting the right diagnosis helps your care team choose the best treatment plan.
The CRSwNP diagnosis process
1. Your symptoms. Your doctor may diagnose CRSwNP if you have two or more of these symptoms that last 12 weeks or longer:
- Ongoing nasal congestion or blockage
- Thick mucus from the nose or down the throat
- Trouble smelling or loss of smell
- Facial pressure or fullness
- Chronic cough or postnasal drip
2. Your medical history. Your medical history is an important part of the diagnosis. Your doctor may ask questions such as:
- How long have your symptoms lasted?
- Do symptoms come and go, or are they always present?
- Have you had repeated sinus infections?
- Have you ever lost your sense of smell?
- Do you have asthma, allergies, or aspirin sensitivity?
- Have you needed oral steroids (steroid pills) or antibiotics in the past?
- Have you had sinus surgery before?
Your answers help your doctor understand whether your symptoms fit CRSwNP or another condition.
3. Physical exam of your nose and sinuses. Your doctor will look for:
- Signs of swelling or inflammation inside the nose or sinuses
- Nasal polyps, which are often found on both sides of the nose but are not always visible during a basic exam
Tests used to confirm CRSwNP
To confirm the diagnosis, your doctor may use one or more of the following tests.
Nasal endoscopy
Your doctor gently places a small camera inside your nose. This allows your doctor to look for swelling, nasal polyps, or blocked sinus openings.
CT scan of the sinuses
A CT scan shows detailed images of your sinuses. It helps doctors see how blocked or inflamed the sinuses are and can guide treatment decisions, including whether surgery may help. Sinus CT scans use a low dose of radiation and are generally considered safe. If you have concerns, talk with your healthcare provider about the benefits and risks.
Allergy testing
Your doctor may do allergy testing to see whether allergies are contributing to your symptoms. This can help guide treatment and trigger avoidance.
When further evaluation is needed
If symptoms are severe, affect only one side of the face, or look unusual, your doctor may refer you to an ENT specialist for a closer evaluation.
Having nasal polyps does not always mean you have CRSwNP. Other conditions, such as cystic fibrosis or eosinophilic granulomatosis with polyangiitis (EGPA, a rare condition that causes inflammation in blood vessels), can also cause nasal polyps. Sharing a detailed symptom history helps your doctor tell these conditions apart and make the right diagnosis.
How doctors tell CRSwNP from other conditions
Some sinus conditions can look like CRSwNP. To make sure you get the right care, your doctor looks for signs that point to other causes of sinus disease. These conditions are less common, but ruling them out is an important part of your evaluation.
Your doctor may look for features such as:
- Allergic fungal rhinosinusitis: This causes thick, sticky mucus that contains fungus. People with this condition have very high IgE levels (a sign of allergic inflammation).
- Sinus disease linked to immune problems: Frequent sinus infections or infections that do not get better with antibiotics.
Looking for these features helps ensure you receive the right diagnosis and the right type of treatment.
Pediatric CRSwNP Considerations
Nasal polyps are not very common in children, but they can happen. When a child has nasal polyps, doctors often want to understand why they developed, since polyps in kids are less typical than in adults.
If your child has these symptoms for several weeks or months, it may be time to see a specialist:
- Always feeling stuffed up
- Trouble sleeping, snoring, mouth breathing, or waking up often at night
- Asthma symptoms that continue even when inhalers are used correctly
- Frequent sinus infections or repeated “sinus colds”
Because nasal polyps are uncommon in children, doctors may recommend extra testing to look for underlying causes:
- Allergy testing to see if allergies to things like dust, pets, or pollen are causing swelling
- Cystic fibrosis (CF) testing, if symptoms suggest it. CF is a genetic condition that affects mucus in the body. Doctors may use a sweat test, which is simple and painless.
Doctors will also check a child’s growth, energy level, and sleep. Long-term nasal blockage can affect rest, focus, and daily functioning, so early evaluation is important.
How is CRSwNP Treated?
CRSwNP treatment focuses on reducing swelling in the nose and sinuses, shrinking nasal polyp tissue, and helping you breathe better. Because CRSwNP is a long-term condition, treatment usually happens in steps over time.
Learning about your treatment options can help you work with your care team to find what works best for you.
How treatment usually progresses
CRSwNP treatment usually follows a step-by-step path. Doctors often start with daily rinses and nasal sprays. If symptoms do not improve or polyps keep coming back, doctors may recommend sinus surgery or biologic medicines. The choice depends on how severe your symptoms are and whether polyps keep returning.
Consider these four steps for your CRSwNP treatment journey.
- Daily rinses and nasal sprays
- Short-term medicines for flares
- Sinus surgery if polyps are too large or blocking airways
- Biologic medicines (injections) if inflammation stays active or polyps come back
Not everyone needs every step. Your doctor will work with you to find the right treatment plan for your situation.
First-line treatment: daily medical care
Most people start with daily treatments that reduce inflammation and help with nasal drainage.
Nasal saline irrigations
- Saline rinses are saltwater washes that help clear out mucus, allergens, and irritants.
- High-volume rinses work best.
- Many people breathe easier and feel less pressure when they rinse daily.
Corticosteroid nasal sprays
Nasal steroid sprays reduce swelling inside the nose.
- Both over-the-counter and prescription options are available.
- Mometasone (Nasonex®) is commonly used to treat nasal polyps and seasonal allergies. It is available over the counter.
If nasal polyps are large, sprays may not reach them well. Some people may notice burning, stinging, or nosebleeds. Using the nasal spray correctly helps it work better and reduces side effects.
Fluticasone with Exhalation Delivery System (EDS™)
This is a prescription nasal steroid that uses your breath to deliver medicine deeper into the nose (brand name Xhance®). When you use the spray, you gently blow into the device. This helps push the medicine into deeper parts of the nose, where nasal polyps often grow, and keeps it from going down your throat.
This treatment may help with nasal polyps and allergy symptoms, and may work better than regular sprays for some people.
Treating related conditions
If you also have asthma or allergies, it is important to keep these conditions under good control. Asthma and CRSwNP are closely linked, and treating one can help improve the other.
Short-term medicines for symptom flares
Sometimes symptoms become more severe or do not improve with daily treatment. Your doctor may recommend short-term medicines. These medicines are not meant for long-term use.
Oral corticosteroids (steroid pills). Oral steroids can quickly shrink nasal polyps and reduce swelling. However, they should be used with caution.
Repeated or long-term use of oral steroids can cause serious side effects. These include weight gain, diabetes, high blood pressure, bone thinning or fractures, eye problems (such as cataracts), thinning of the skin, and easy bruising. Because of these risks, doctors try to limit how often oral steroids are used.
Leukotriene modifiers. Medicines like montelukast may help some people with CRSwNP. They can block chemicals that cause inflammation and polyp growth. The medicines are used carefully because they can affect mood or mental health in some patients.
What are potential complications in treating CRSwNP?
Most people with CRSwNP manage their condition safely with the right care. Serious problems are not common, especially when symptoms are treated early and followed closely by a doctor.
When complications do happen, they are usually related to severe disease or untreated infection rather than routine care.
The sinuses sit very close to the eyes and brain. In severe or untreated cases, infections can sometimes spread.
- Eye problems (orbital issues). The bone between the sinuses and the eyes is very thin. In rare cases, infection can spread to this area and cause eye swelling, pain, or vision changes.
- Infection spreading. Very rarely, a sinus infection can spread to nearby bone or toward the brain. This can cause severe headache, stiff neck, or high fever, and needs urgent care.
- Severe uncontrolled inflammation. If swelling is not well-controlled, the nose can become completely blocked. This can make it very hard to breathe through the nose or smell anything at all.
Complications from treatment
- Steroid pills: short courses are helpful, but using oral steroids too often can lead to side effects such as weight gain, bone thinning, mood changes, or eye problems.
- Surgery: sinus surgery is generally safe, but like any surgery, it carries risks such as bleeding, infection, or scarring inside the nose.
- Biologic treatments: biologics are considered very safe for most people. Some may notice mild side effects, such as soreness at the injection site or eye irritation like pink eye.
When Daily Treatment is Not Enough
If symptoms continue despite regular rinses, nasal sprays, and short-term medicines, your doctor may talk with you about other options. These can include sinus surgery or biologic medications, depending on how severe your symptoms are and how often nasal polyps return.
Sinus procedures and surgery
If nasal polyps are very large or if there are many of them, your doctor may recommend sinus surgery. Surgery removes nasal polyps and opens blocked sinus passages to help you breathe better.
Sinus surgery does not cure CRSwNP or treat the reason why the polyps grow. It helps reduce blockage and allows medicines to work better afterward. Because CRSwNP is a long-term condition, nasal polyps can come back over time, and ongoing treatment is usually still needed.
Endoscopic sinus surgery (ESS or FESS)
The most common surgery for CRSwNP is called endoscopic sinus surgery, also known as functional endoscopic sinus surgery (FESS).
During this procedure, an ENT specialist uses small tools and a camera to remove nasal polyps and open blocked sinus passages. This surgery can:
- Improve breathing and your sense of smell.
- Reduce pressure and congestion.
- Help nasal sprays and rinses work better.
Some people may need additional treatment later if polyps return.
Balloon sinuplasty
In this procedure, a small balloon is used to open blocked sinus passages. In some cases, polyps may be removed at the same time. This option is not right for everyone. It depends on the shape and size of your sinuses and how severe your symptoms are.
Corticosteroid-eluting sinus implants
Corticosteroid-eluting implants such as Sinuva® may be placed during or after surgery. These implants work by:
- Releasing steroid medicine directly into the sinus tissue over several weeks
- Reducing inflammation
- Providing benefits that can last for months and may lower the chance of polyps returning
What are the risks of sinus surgery?
Sinus surgery is generally safe, but risks can include:
- Bleeding
- Infection
- Scar tissue
- Polyp regrowth
- Need for additional surgery in the future
- In rare cases, changes in smell or vision
Your surgeon will review your individual risk factors with you.
What to Expect after Surgery
Most people feel relief soon after sinus surgery, but healing takes time. Here’s what you can expect during recovery:
Right after surgery:
- You may still feel congestion even though the polyps were removed. This is normal.
- A little bloody drainage from your nose is common for the first few days.
- Your sense of smell may take weeks to improve as swelling goes down.
Managing discomfort:
- Mild pain or pressure is expected.
- Your doctor may recommend over-the-counter pain medicine.
- Sleeping with your head elevated can help reduce swelling.
- Avoid blowing your nose for a few days unless your doctor says it is okay.
Healing at home:
- Many people return to normal activities within 1 to 2 weeks.
- Saline rinses are often recommended to keep sinuses clean.
- Your doctor will tell you when it’s safe to restart nasal steroid sprays.
Follow-up visits:
- Your ENT specialist will schedule visits to check healing and clean the nasal passages.
- These visits help prevent infection and reduce the chance that polyps return.
Long-term benefits:
- Many people breathe more easily and feel less pressure.
- Surgery opens the sinus pathways so medications can work better long-term.
If anything feels unusual or symptoms suddenly worsen, contact your care team.
Advanced treatment: biologic medications
If CRSwNP symptoms continue or nasal polyps come back even when using regular nasal sprays, short-term medicines, or surgery, your doctor may recommend biologic treatment.
Biologics are injectable medicines (shots) used for moderate to severe CRSwNP. They treat the root cause of swelling – the underlying inflammation that causes nasal polyps – rather than just treating symptoms.
How biologics work
Biologics target type 2 inflammation, which plays a key role in CRSwNP. This type of inflammation involves immune cells and signals that stay active for too long.
One important immune cell involved is the eosinophil. Eosinophils are white blood cells that help fight illness. In CRSwNP and asthma, eosinophils can become overactive and cause extra swelling in the nose, sinuses, and lungs. By calming this immune response, biologics help reduce ongoing inflammation.
Biologic medications taken for nasal polyps can help:
- Shrink nasal polyps
- Improve congestion and breathing
- Restore sense of smell
- Reduce the need for oral steroids
- Lower the chance of surgery
- Improve quality of life
Many people begin to notice improvement within about 4 weeks, with benefits continuing to increase over several months.
What to expect from biologics for treating nasal polyps
Biologics usually do not make nasal polyps disappear completely. The goal is disease control. This means polyps shrink enough to help you breathe, smell, and feel better.
Because CRSwNP is a chronic inflammatory condition, nasal polyps often return if biologic treatment is stopped. Biologics are used as ongoing maintenance therapy and work best when combined with regular daily treatments.
Approved biologics for CRSwNP
The following biologics are approved to treat chronic rhinosinusitis with nasal polyps:
- Dupilumab (Dupixent®). Helps reduce nasal polyp size and improve nasal symptoms.
- Omalizumab (Xolair®). May help people with CRSwNP who also have allergic asthma or high IgE levels.
- Mepolizumab (Nucala®). Shown to reduce nasal polyp size and improve symptoms in some people with CRSwNP.
- Tezepelumab-Ekko (Tezspire®). Can help people who have high levels of eosinophils or high IgE levels.
Your healthcare team will help decide whether a biologic is right for you. The decision should be based on your symptoms, medical history, and other health conditions such as asthma. If you have more than one condition, your doctor may choose a biologic that can treat multiple conditions at once.
How long does treatment take to work?
The time it takes to feel better depends on which treatment you are using:
- Saline rinses: You may feel cleaner and less “clogged” immediately after washing out mucus.
- Steroid nasal sprays: These take longer because they have to slowly shrink the swelling. Most people start to feel a difference in 2 to 4 weeks.
- Biologics: These treatments work deep inside your immune system. Many people notice they can breathe better within 4 to 6 weeks, but it can take up to 4 to 6 months to see the full benefit.
- Surgery: You will feel very “stuffy” right after surgery while you heal. Most people start feeling much better after 2 to 3 weeks.
CRSwNP Long-Term Management and Follow-up
CRSwNP is a long-term condition for many people. Sinus symptoms may improve with treatment but can return over time. Even after surgery or biologic treatment, ongoing care helps keep inflammation under control and lowers the chance that nasal polyps come back.
Long-term management focuses on daily care, regular follow-up, treating related conditions, and supporting overall well-being.
Daily care to keep symptoms under control
Alongside medical treatment, small daily steps can help ease discomfort and support sinus health:
- Drink fluids to help keep mucus thinner
- Use warm compresses on the nose or face to ease pressure
- Take steam showers to moisten nasal passages
- Use saline spray if dryness is a problem
Most long-term care plans include daily treatments that protect the sinuses and reduce swelling, such as:
- Daily saline nasal rinses
- Intranasal corticosteroid sprays
These treatments help clear mucus, calm inflammation, and reduce the risk of polyp regrowth. Using them consistently, even when symptoms improve, is an important part of staying well.
How to use a saline rinse safely
Saline rinsing is a key part of long-term care. To use it safely:
- Use distilled, sterile, or previously boiled and cooled water.
- Never use tap water unless it has been boiled first and allowed to cool.
- Warm water may feel more comfortable.
- Rinse once or twice daily, or as often as your doctor recommends.
- Neti pots, squeeze bottles, and nasal irrigation devices all work well.
Regular follow-up with your care team
CRSwNP cannot be “cured,” but it can often be well controlled with the right plan and regular follow-up.
Follow-up visits help:
- Catch inflammation early
- Adjust treatment before symptoms worsen
- Reduce the chance that polyps return
During visits, an ENT specialist may use a small camera, called a nasal scope, to check for swelling or new polyps. These appointments also give you time to review what is working and make changes as needed.
Managing related conditions
Many people with CRSwNP also have other conditions that affect inflammation. Keeping these well-controlled can improve sinus symptoms and breathing overall.
- Asthma. Using inhalers as prescribed and preventing flare-ups helps reduce inflammation in both the lungs and sinuses.
- Allergies. Avoiding triggers and using allergy treatments can lower swelling in the nose and sinuses.
- Aspirin or NSAID sensitivity. If you have an aspirin or NSAID sensitivity, such as with AERD, avoiding these medicines (or following your doctor’s plan) can help prevent sinus and breathing symptoms.
Immunotherapy
If you know that environmental allergies contribute to your symptoms, your doctor may recommend allergen immunotherapy. This involves allergy shots or tablets that dissolve under your tongue. This treatment helps retrain the immune system over time to react less strongly to allergens. It may also reduce nasal inflammation.
For people with AERD, your care team may also discuss aspirin desensitization therapy.
Mental health and CRSwNP
Living with a chronic condition like CRSwNP can be tiring and frustrating, especially when symptoms come and go. Ongoing congestion, poor sleep, or loss of smell can affect your mood, energy, and motivation over time.
Living with CRSwNP can also be hard because family, friends and co-workers may not understand your symptoms. They may misinterpret your condition as just a bad mood.
Taking care of mental health is part of long-term management. Let your care team know if symptoms are affecting your sleep, stress levels, or emotional well-being. Support from healthcare providers, loved ones, or mental health professionals can help you manage CRSwNP over time.
Are there treatment guidelines for chronic rhinosinusitis with nasal polyps?
Yes. Treatment guidelines for CRSwNP were published in 2014 in the Annals of Asthma, Allergy, and Immunology. These guidelines help doctors follow consistent, evidence-based approaches to managing CRSwNP.
Environmental and Lifestyle Support
Daily habits and the surrounding environment can play an important role in managing sinus problems over time. Making even small changes can help reduce symptoms and support the treatments you are already using.
Environmental control strategies
Making small changes at home, school, or the office can help protect your sinuses and support long-term symptom control.
- Use HEPA air filters (special filters that trap tiny particles) to reduce dust, pollen, and pet dander.
- Keep humidity between 30–50% to prevent dryness and mold growth.
- Fix water leaks and clean mold quickly.
- Wash bedding weekly in hot water to reduce dust mites.
- Keep pets out of the bedroom if you are allergic.
Smoking and secondhand smoke
Smoke and airborne irritants can worsen CRSwNP symptoms because:
- Smoke particles irritate the lining of the nose and sinuses.
- Irritants increase swelling and mucus production.
- This can worsen congestion, pressure, and nasal polyps.
Sources of smoke and irritants include:
- Cigarette smoke and secondhand smoke
- Wood-burning fires or wildfire smoke
- Candles and incense
- Heavy air pollution or fumes
Avoid smoke and strong irritants when possible. If you smoke and want help quitting, talk to your doctor. They can connect you with support.
Lifestyle factors
Healthy habits can support overall health and breathing. These changes are not about perfection. Even small steps can make a difference.
- Weight. Maintaining a healthy weight may help, as excess body weight can increase inflammation. It can also make symptoms harder to control.
- Exercise. Regular physical activity supports overall health and breathing.
- Diet. No diet cures CRSwNP. Balanced meals with fruits, vegetables, and whole foods may help support immune health.
- Sleep. Ongoing congestion can disrupt sleep. Using treatments as directed, rinsing before bed, and keeping nasal passages clear may help improve sleep quality.
These lifestyle choices work alongside medical treatment to help you feel better and stay in control over time.
Navigating Care, Support, and Costs
Managing CRSwNP involves working with your care team, understanding the healthcare system, and knowing where to get help when treatment becomes complex or expensive.
Working with your care team
CRSwNP often needs care from more than one healthcare provider. Each plays a different role in helping you stay well.
Your care team may include:
- ENT specialist: treats nasal polyps and sinus blockage.
- Allergist: helps manage allergies, asthma, and immune-related inflammation.
- Pulmonologist: supports asthma and lung health when needed.
- Primary care clinician: helps coordinate care and manage overall health.
When these providers work together, treatment plans are better coordinated and long-term control is easier to maintain.
When should I see a specialist such as allergist, ENT or pulmonologist?
You should see a specialist if you notice:
- Nasal congestion or sinus pressure lasting more than 12 weeks
- Loss of smell
- Medicines are not working
- Frequent sinus infections needing antibiotics
- Asthma that is getting harder to control
You should also see a specialist regularly if:
- You have had sinus surgery: to check that polyps are not returning.
- You are using a biologic: so your doctor can track how well it is working.
Regular visits help keep symptoms under control and prevent problems before they worsen.
How can healthcare professionals help people with CRSwNP?
Living with CRSwNP can be tiring and frustrating. Many people deal with daily congestion, loss of smell, pressure, headaches, poor sleep and low energy.
Healthcare professionals can help most by:
- Explaining treatment options in clear, simple terms.
- Working with you to choose a treatment plan that fits your life.
- Checking in regularly to see what is working and what is not.
- Listening and taking symptoms seriously.
Feeling heard and supported makes long-term care easier to manage.
The role of the pharmacist
Pharmacists are an important part of your care team. They can:
- Explain how to use medications correctly.
- Review possible side effects.
- Help answer questions about injections or nasal sprays.
- Assist with insurance coverage, copays, and refills.
If something about your medication is confusing, your pharmacist can often help right away.
Questions to ask your doctor
When you go to a doctor’s appointment, be ready to share your health history, current symptoms, and a list of medications you take.
Doctor visits are also a chance to get answers and plan next steps. You may want to ask:
- What is causing my symptoms?
- What can I do at home to help my symptoms and reduce chronic inflammation?
- What are the treatment options?
- How long should I expect to wait to see improvement in symptoms once I start treatment?
- Should I consider surgery for my nasal polyps?
- Are there any side effects to worry about from treatment?
- When should I follow up or consider seeing a specialist?
- What lifestyle changes should I consider to help manage my CRSwNP?
Writing questions down ahead of time can help you get the most out of your visit.
Insurance, costs, and access to treatment
Some CRSwNP treatments, especially biologics and surgery, may involve insurance approval or higher costs. Knowing what to expect can reduce stress.
This may include:
- Prior authorization (approval from your insurance before starting treatment) for biologic medicines.
- Insurance appeals if coverage is denied.
- Copay or patient assistance programs offered by manufacturers or foundations.
- Understanding surgery costs, including hospital fees and follow-up care.
If you run into insurance problems, ask your care team or pharmacist for help. You may also want to explore our Health Insurance Toolkit for step-by-step guidance and support.
Questions & Answers (Q&A) about CRSwNP
You may have specific questions about your CRSwNP symptoms or diagnosis. Here’s a Q&A with some of the more common questions about this condition. If there’s something you’d like to see covered, please email our editor.
June 2026
Reviewed by:
Bradley Chipps, MD, FACAAI, is a board-certified allergist and pediatric pulmonologist with Capital Allergy and Respiratory Disease Center in Sacramento, California. He earned his medical degree from University of Texas Medical Branch in Galveston in 1972. He is Past President of the American College of Allergy, Asthma and Immunology (ACAAI).
