Chronic Rhinosinusitis With Nasal Polyps

Chronic Rhinosinusitis With Nasal Polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic condition that can cause frustrating symptoms, from sinus pressure and nose stuffiness to loss of smell. Nasal polyps are growths in the nose or sinuses. They are not cancerous, but they can make you miserable and interfere with your quality of life, and make sleeping difficult.

CRSwNP affects about 1–4% of U.S. adults (roughly 13 million people), and among those with chronic sinus inflammation, 25–30% have CRSwNP. The condition typically appears between ages 40 and 60, and more than half of patients also have asthma.

Treatment options include nasal or oral medications, biologic medications, and surgery. Many patients aren’t aware that these polyps may grow back. Your doctor can work with you to try another treatment if necessary. You may see more than one type of doctor, such as an allergist and an ear, nose, and throat (ENT) specialist (otolaryngologist). Sometimes, these two types of doctors will work together to review your diagnosis and suggest treatment options.

Symptoms & Diagnosis

• Stuffy or runny nose
• Loss or decreased sense of smell
• Facial pressure or pain
• Postnasal drip (mucus running down the throat)
• Upper tooth pain
• Snoring, sleep disturbance or headache

If you have had any of these symptoms for longer than three months, see your allergist or ENT.

Many people with nasal polyps also have asthma. Inflamed sinuses from nasal polyps can make asthma worse. Your allergist can work with you to control both conditions. In many cases, treating nasal polyps can improve your asthma control.

Diagnosis May Involve:

• Nasal endoscopy (a small camera in the nose) performed in the office to see polyps directly
• CT scan to see the sinus passages
• Allergy or blood testing to help identify triggers and inflammation type

Managing Symptoms at Home

To Reduce Triggers

• Avoid tobacco smoke, incense, aerosol sprays, and chemical fumes.
• Use an air purifier and control indoor air humidity (40-50%).
• Limit nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen if you have AERD.

Your sinuses rely on tiny hairs in your nose (cilia) to move mucus out and trap and clear irritants and germs. In CRSwNP, inflammation thickens mucus and slows this movement, worsening congestion.

To Improve Mucus Flow:

• Use a saline (saltwater) spray or nasal rinse daily
• Rinse nasal passages only with distilled, sterile, or boiled-then-cooled water — never plain tap water.
• Clean your device, such as a neti pot or squeeze bottle, after each use.
• Use a humidifier and stay hydrated to thin mucus.

Medical Treatments (Steroids, Surgery, Biologics)

If home remedies don’t provide relief, your allergist or ENT may recommend one or more of the following treatments, depending on your symptoms and the number and size of your polyps:

Corticosteroid Nasal Sprays

Several over the counter or prescription intranasal corticosteroid (INCS) (nasal sprays) are available to help relieve symptoms and can be sprayed once or twice daily in each nostril. These medications are easy to use and inexpensive, but they can cause burning and stinging, or bleeding in the nose, and may not work well if your polyps are large.

Breath-Powered Fluticasone Device (Xhance®)

This device delivers corticosteroid medication deeper into your nose using your own breath. You must be able to breathe out strongly for the device to work, and it must be used every day.

Oral Corticosteroids

Short courses of oral corticosteroids (OCS) are common for flare-ups and can offer temporary relief. However, they may not address the root cause of inflammation.

Sinus Surgery

If your nasal polyps are large and medications haven’t helped, your ENT may recommend endoscopic sinus surgery to remove them. Your surgeon can also make the sinus opening larger, so medications work better. With surgery, you usually need to continue to take medications. Over 40% of patients who had surgery experienced a recurrence of nasal polyps within a few years.

Biologic Medications

These targeted antibody medications, often prescribed to asthma patients to treat underlying inflammation, can also be used to treat and reduce the size of nasal polyps. Biologics are injected under your skin and may need to be taken long-term. While on a biologic for CRSwNP, your allergist may track congestion and smell scores, the need for oral steroids or surgery, and endoscopy results. Regular follow-ups (often every 3–6 months initially) help ensure correct dosing and maximum benefit.

FDA-Approved Biologics for CRSwNP
(Note: These are add-on medications, which means they are used in addition to standard treatments such as nasal corticosteroids.) Each product targets different inflammatory pathways, and if they don’t respond to one, they may do better with another.

• Dupilumab (Dupixent®) is an add-on maintenance medication for patients 12+ with uncontrolled CRSwNP. It is self-injected every two weeks.
• Omalizumab (Xolair®) is an add-on medication for adults 18+ with uncontrolled CRSwNP. It is injected every two to four weeks, starting in your allergist’s office and sometimes later at home.
• Mepolizumab (Nucala®) is an add-on medication for adults 18+. It is an add-on medication for adults 18+ with CRSwNP. Like the other biologics, it is used along with standard treatments when symptoms are still not well controlled.
• Tezepelumab (Tezspire®) is an add-on for patients 12+ with uncontrolled CRSwNP. It is given as an injection and is the first biologic targeting TSLP.

If Nasal Polyps Come Back

Even after surgery or medications, polyps can regrow, and their frustrating symptoms can come back. Long-term management may include:

• Continuing nasal corticosteroids or saline rinses
• Switching or adding a biologic therapy
• Repeat endoscopic surgery if necessary

For some patients with polyps returning after surgery, Sinuva® sinus implants, also called stents, may be an option. They slowly release medication directly inside the sinus cavity for about 90 days before dissolving. The procedure can be performed in an ENT’s office. The benefits of the implants last several months, and your doctor may recommend you continue using a corticosteroid nasal spray and/or saline rinse or spray. You may need the implant procedure again once the benefits wear off.

Frequently Asked Questions

Are nasal polyps the same as sinus infections?

No. Sinus infections are often caused by bacteria or viruses, while chronic rhinosinusitis with nasal polyps involves long-term inflammation of the sinus lining. You can have both at the same time, but CRSwNP tends to come back even after the infections clear.

Can children or teens have CRSwNP?

It’s uncommon but possible. When CRSwNP is present, clinicians may evaluate for underlying conditions such as cystic fibrosis or significant eosinophilic inflammation. Tezspire and Dupixent are approved for patients 12 years of age and older with CRSwNP.

Can CRSwNP occur with eczema or eosinophilic esophagitis?

Yes. These are all Type 2 inflammatory diseases that share immune pathways. Treating one often improves the others.

Do antibiotics help nasal polyps?

Antibiotics address bacterial infections but do not treat the inflammatory cause of polyps; they’re used only when a bacterial sinus infection occurs at the same time as CRSwNP.

How soon can the sense of smell improve after treatment?

Smell can improve within weeks as swelling decreases and mucus clears, but recovery may take months. Results vary depending on the treatment used.

Find an Allergist

If you or your child struggles with chronic sinus blockage, loss of smell, or nasal polyps that don’t respond to medication, an allergist can identify underlying inflammation and tailor advanced therapies.

Find an Allergist

This page was reviewed for accuracy 7/27/2021. It was most recently updated 1/19/2026.

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