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Management of CRSsNP
Identification and Treatment of Chronic Rhinosinusitis Without Nasal Polyps

Released: October 28, 2024

Expiration: October 27, 2025

Brent Senior
Brent Senior, MD
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Key Takeaways
  • Long-term condition: Chronic rhinosinusitis without nasal polyps (CRSsNP) requires ongoing management; there is no one-time fix. 
  • Symptom duration matters: Chronic symptoms persisting for weeks or months indicate CRSsNP. 
  • Tailored treatment: A combination of medical and, if needed, surgical options can significantly improve patient outcomes. 

Chronic rhinosinusitis without nasal polyps (CRSsNP) is a common issue healthcare professionals (HCPs) see in clinics, both in primary care and specialty settings. It is important to understand that the pathologic mechanisms differ between patients with polyps and those without, which impacts how HCPs manage the disease. I want to share some practical insights into how I approach CRSsNP in my practice to help improve patient care. 

Identifying CRSsNP: Duration Is Key 
Duration is one of the first things I look at when patients present with symptoms of sinusitis. If patients have had symptoms for only a short time, the issue is often an acute viral or allergic response that can resolve quickly with appropriate treatment. However, when the symptoms have persisted for months, I begin to suspect CRS. 

The key here is that patients with CRSsNP will say their symptoms never fully go away. Symptoms might improve for some time, but then they flare up again. This is a hallmark of CRS—the symptoms persist over time, and patients often feel they never truly return to normal. 

Importance of Accurate Diagnosis 
Many patients are referred after being treated for chronic rhinitis or suspected sinusitis without much improvement. When I see these patients, I take a detailed history and perform diagnostic imaging, like a sinus computed tomography (CT) scan, to confirm the diagnosis. The absence of nasal polyps changes how treatment is approached, as the underlying inflammation in CRSsNP tends to differ from the eosinophilic inflammation observed in patients with polyps. 

Treatment: A Long-term Approach 
CRSsNP is a chronic disease, and it generally requires ongoing management. The goal is not necessarily to cure patients, but rather to help them live more comfortably by reducing the impact of symptoms on their daily lives. 

For most patients, treatment involves a combination of nasal corticosteroids and saline irrigation to control inflammation and keep the sinuses draining properly. When bacterial infections are present, antibiotics may be necessary, but the focus is often on managing the inflammation rather than treating the infection. I make sure to set expectations that this is long-term management and that patients will need to stay on top of their treatment to keep their symptoms in check. 

Surgical Options 
For patients who do not respond well to medical management, surgery, such as functional endoscopic sinus surgery (FESS), can be a good option. Surgery can improve sinus drainage and provide significant symptom relief, but it is not a cure. Patients will often still need to continue medical management even after surgery to maintain their improvements. 

Conclusion 
CRSsNP is a chronic condition that requires careful management. By understanding the nature of the disease and tailoring treatments to individual patients, HCPs can help them manage their symptoms and improve quality of life. 

Your Thoughts? 
What are your biggest challenges in managing CRSsNP? Let’s discuss approaches that have worked for your patients!  

To learn more about CRSsNP, join our webinar on November 8, 2024, where I will discuss this topic in more detail.

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