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Inflammation is the body’s natural response to germs, irritants, and foreign substances like chemicals. When this inflammation affects the lining inside the nose and spreads to the sinuses, it’s known as rhinosinusitis. Sinuses are air-filled spaces surrounding the nose.
Common symptoms of rhinosinusitis include nasal congestion, reduced or lost sense of smell, facial pain or pressure, and mucus that either drips from the nose or drains down the back of the throat.
When these symptoms persist for more than 12 weeks, it is classified as Chronic Rhinosinusitis (CRS). CRS can occur with or without nasal polyps—soft, non-cancerous growths in the nose or sinuses that may cause discomfort and disrupt daily activities.
The exact reason why some individuals with CRS develop nasal polyps while others do not is still unknown. CRS with nasal polyps is often referred to as Nasal Polyp Syndrome.
Chronic rhinosinusitis (CRS) with nasal polyps often runs in families, suggesting a genetic component to the condition. However, CRS without nasal polyps has also been observed in family members, indicating that hereditary factors play a role in both forms of the disease.
Studies involving identical twins have shown that both siblings may not necessarily develop nasal polyps, highlighting the significant role of environmental factors alongside genetic predisposition. This emphasizes that both inherited traits and external influences contribute to the development of CRS.
Sinuses are air-filled cavities located within the bones of your face and skull, lined with a thin, moist layer of mucus. Together with the nose, the sinuses play a crucial role in filtering, warming, and humidifying the air we breathe. This process helps protect the lungs from harmful particles and irritants.
In addition to respiratory functions, the sinuses also contribute to the resonance of your voice, influencing how you sound when speaking. Furthermore, the sinuses act as a cushion, absorbing energy to protect the brain in the event of an accident.
Around 10% of people are affected by chronic rhinosinusitis (CRS), which is roughly equivalent to the entire population of Spain. In certain regions of Europe, the prevalence of CRS is even higher, highlighting the widespread impact of this condition across the continent.
When the inner lining of the nose becomes inflamed and the inflammation spreads to the nearby sinuses, the condition is called rhinosinusitis. While the terms sinusitis and rhinosinusitis are often used interchangeably, rhinosinusitis more accurately reflects the condition affecting both the nose and the sinuses. Despite this distinction, both terms are commonly used to describe the same underlying condition.
Chronic rhinosinusitis (CRS) can evolve as you age. In children, CRS is typically milder, and nasal polyps (soft, painless growths in the nose or sinuses) are rare unless the child has a condition like cystic fibrosis.
In adults, CRS with nasal polyps can worsen if left untreated. Over time, polyps can grow larger, pressing against the bones in the face and sometimes altering their appearance.
Another sign that CRS may be worsening is the development of asthma-like symptoms, such as shortness of breath, wheezing (a whistling sound while breathing), coughing, or coughing up mucus from the chest. If you experience any of these symptoms, it’s important to consult your doctor for further guidance.
Chronic rhinosinusitis (CRS) is typically not curable, but its symptoms can often be managed and controlled with appropriate treatment. The condition involves long-term inflammation of the sinuses, which can be challenging to treat.
The causes of this inflammation can vary, including infections, allergies, structural abnormalities in the nose, or immune system issues. Fortunately, many people experience less severe symptoms as they reach the age of 60. With proper care and management, CRS can be effectively controlled to improve quality of life.
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While the exact cause of chronic rhinosinusitis (CRS) is not fully understood, it is believed to result from a combination of factors that contribute to the development of the disease. This includes an interaction between personal traits, such as genetics, and environmental factors like air pollution, cigarette smoke, and allergens.
These factors together trigger long-lasting inflammation in the sinuses and nasal cavity, leading to the symptoms associated with CRS. Understanding this interaction is key to better managing and treating the condition.
Inflammation is the primary cause of chronic rhinosinusitis (CRS) and can be triggered or worsened by various factors such as infections (bacterial and viral), smoking, air pollution, and allergens. This inflammation leads to thickening of the inner lining of the nose and sinuses, increased mucus production, and sometimes the formation of polyps, which contribute to CRS symptoms.
It’s important to note that CRS is not simply an “infection that won’t go away.” Many bacteria and fungi naturally reside in our sinuses, even in people who do not have sinus disease. While bacteria and viruses may contribute to inflammation, killing them with antibiotics does not cure CRS. Instead, the condition is likely caused by a combination of factors, including environmental influences and genetic predisposition, resulting in the persistent inflammation characteristic of CRS.
The exact role of allergies in contributing to chronic rhinosinusitis (CRS) is not fully understood, but it is clear that allergies are more common among people with CRS than in the general population. This is particularly true for year-round allergies, such as those to moulds or house dust mites.
Poorly controlled allergies can worsen CRS symptoms, and individuals with allergies often experience more severe and recurrent CRS. Furthermore, allergies frequently co-exist with asthma, adding another layer of complexity to managing CRS. Understanding the relationship between allergies, asthma, and CRS is crucial for effective treatment and symptom management.
Yes, environmental factors can contribute to the development of chronic rhinosinusitis (CRS). Breathing in certain chemicals, gases, or contaminated water can irritate the inside of your nose and sinuses, leading to inflammation. If this exposure happens repeatedly, it can cause long-lasting swelling and symptoms like nasal congestion or mucus buildup.
However, CRS typically results from a combination of factors. Along with environmental irritants, other causes such as allergies or structural problems in the nose may also play a role in the development of CRS, sometimes without being immediately noticeable. These factors together contribute to the condition’s persistence.
Poor indoor air quality, combined with allergens like mould or dust mites, can irritate the nose and sinuses, especially in individuals who are sensitive to these triggers. This irritation can lead to swelling, which may result in chronic rhinosinusitis (CRS), with or without nasal polyps.
However, it’s difficult to pinpoint poor air quality as the sole cause of CRS. The condition typically arises from a combination of factors, including genetics, infections, and environmental influences. These elements likely interact with indoor air quality to contribute to the development and persistence of CRS.
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People with rhinosinusitis typically experience at least two of the following symptoms:
In some cases, patients may also experience ear or tooth pain, bad breath, sore throat, irritability, depression, or fatigue. Rhinosinusitis is classified as chronic when these symptoms persist for at least 12 consecutive weeks.
A common cold is a viral illness that affects the nose and throat. It is typically self-limiting, meaning it resolves on its own within about a week without medical treatment.
Acute rhinosinusitis is a condition that affects both the inner lining of the nose and the sinuses, often triggered by a viral infection from the common cold. Like the cold, acute rhinosinusitis is usually self-limiting but can last a few weeks.
Chronic rhinosinusitis (CRS), on the other hand, is much more complex. It is not simply “an infection that won’t go away.” CRS involves a combination of factors, including the immune system, genetics, and environmental influences. While infections can trigger or worsen CRS, the ongoing inflammation characteristic of the condition cannot be explained by infection alone.
To be diagnosed with CRS, symptoms must persist for at least 12 weeks, and the disease is typically confirmed through a nasal endoscopy, where a physician uses a camera to examine the inside of the nose.
A sinus infection caused by a virus can turn into a bacterial infection if:
Signs of a Serious Bacterial Infection
If the bacterial infection becomes more serious, look for these warning signs that may require urgent care:
If any of these symptoms occur, contact a doctor immediately for evaluation and treatment.
When diagnosing chronic rhinosinusitis (CRS), the doctor may examine the inner lining of the nose, which might appear swollen, red, and irritated. A nasal endoscopy, using a small camera to look deeper into the nose, can help the doctor detect nasal polyps or secretions coming from the sinus openings.
During a throat exam, the doctor may also observe thick, coloured mucus dripping from the back of the nose into the throat, known as post-nasal drip.
In some cases, a CT scan of the head may be recommended to further investigate the sinuses. While not necessary for all patients, a CT scan can be helpful when the diagnosis is unclear or additional treatment needs to be planned.
While there are no specific blood tests to diagnose CRS, some patients may undergo a blood test to check for potential allergies or to rule out immune deficiencies or autoimmune disorders.
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Nasal polyps are soft, non-cancerous growths in the nose and/or sinuses that can cause symptoms and significantly interfere with daily life. One of the most common symptoms for people with nasal polyps is a poor sense of smell.
When nasal polyps develop, the condition is referred to as Nasal Polyp Syndrome or CRS with Nasal Polyps (CRSwNP). This form of chronic rhinosinusitis (CRS) is often more severe and may require specialized treatment to manage symptoms.
Nasal polyps that occur with chronic rhinosinusitis (CRS) are non-cancerous and do not develop into cancer. However, other growths in the nasal cavity that may look like polyps could be cancerous or have the potential to become cancerous over time.
Therefore, it’s crucial to have nasal polyps properly examined by a doctor. This is often done using a procedure called nasal endoscopy, where a small camera is inserted to look inside the nose. In some cases, additional scans may be necessary for further evaluation.
Extra caution is needed if you experience any of the following symptoms:
If you notice these symptoms, contact a doctor for immediate evaluation.
Small nasal polyps may not cause noticeable symptoms. However, the inflammation associated with chronic rhinosinusitis with nasal polyps (CRSwNP) can lead to symptoms like:
As the polyps grow larger, they can block the nasal passages, leading to a stuffy nose and making it harder to breathe through the nose. This can significantly affect daily life and may require treatment to manage the symptoms and reduce the size of the polyps.
Nasal polyps are small, grape-like growths caused by chronic inflammation in the nose and sinuses. This persistent inflammation not only causes the polyps to grow and stay but also leads to symptoms such as:
To reduce the risk of polyps returning or growing larger, it is recommended to follow anti-inflammatory treatments, such as corticosteroids, and to regularly rinse with saline. These treatments help manage inflammation and maintain clearer nasal passages.
Turbinates are normal structures in everyone’s nose. Made of bone and covered by the inner lining of the nose, turbinates help warm and moisten the air you breathe, which is essential for protecting your lungs. They can become swollen during a cold or due to allergies, but this swelling usually goes down once the underlying cause is treated.
Nasal polyps, however, are not normal. They are soft, non-cancerous growths that develop when the inner lining of the nose becomes inflamed or diseased. Unlike turbinates, polyps do not go away on their own and can lead to symptoms such as:
Proper treatment is necessary to manage polyps and their symptoms.
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Certain lifestyle factors can have a significant impact on chronic rhinosinusitis (CRS). Exposure to cigarette smoke, irritants (such as those at work), and air pollution can irritate the airways, making it more difficult for your nose and sinuses to clear mucus effectively.
Specifically, cigarette smoke increases the risk of airway infections, which can worsen CRS symptoms. It can also impair your ability to breathe through your nose and negatively affect your sense of smell. Reducing exposure to these irritants can help manage CRS and improve overall respiratory health.
When I drink alcohol, I have more symptoms. I think I am allergic to it. Is that possible?
Many patients with chronic airway disease, including those with chronic rhinosinusitis (CRS), notice that their symptoms worsen after consuming alcohol. While the exact cause of this intolerance is not fully understood, it is not related to an allergy to alcohol. Instead, alcohol can intensify nasal symptoms, leading to a more severely blocked nose, and may even trigger asthma attacks in individuals with asthma.
People with CRS with nasal polyps seem to be more sensitive to alcohol compared to those without nasal polyps. If you find that alcohol worsens your symptoms, reducing or limiting your intake may help improve symptom control and overall comfort.
Smoking, including using e-cigarettes and other tobacco products, contributes to a range of diseases and worsens numerous conditions, including chronic rhinosinusitis (CRS). It irritates the lungs, nose, and sinuses, which can significantly worsen CRS symptoms. While the impact of smoking is problematic for all smokers, it tends to be more severe for those with CRS. Quitting smoking can help you regain better control over your symptoms and improve overall health.
Quitting smoking is not easy, and many individuals need multiple attempts to succeed. However, with determination and support from family, friends, or coworkers, you can increase your chances of success. There are also numerous resources and professional help available to assist you in your journey to quit smoking for good, offering a healthier future for you.
Yes, dental issues can contribute to chronic rhinosinusitis (CRS). Infections in the bones around your teeth, especially the upper teeth, can spread to the nearby sinuses, which are located just above the upper jaw. This often results in rhinosinusitis affecting just one side of the face.
To effectively treat this type of rhinosinusitis, it is essential to first address the dental infection causing the problem. Once the dental issue is resolved, your doctor can then focus on treating the sinusitis. If you suspect that your sinus problems are linked to your teeth, it’s important to inform both your doctor and dentist, so they can work together to manage your condition effectively.
Smoking and exposure to cigarette smoke can significantly worsen sinus issues. The smoke irritates the airways, making it harder for your nose and sinuses to clear mucus. This irritation can increase the risk of infections, make it more difficult to breathe through your nose, and can even reduce your sense of smell.
Additionally, active smoking may also affect the success of surgical treatments for sinus conditions. If you’re considering surgery, it’s crucial to talk to your healthcare provider about smoking cessation as soon as possible to improve both your sinus health and the outcome of any medical treatments.
Researchers are continuing to explore the potential links between factors like stomach acid reflux, diet, and the bacteria naturally found in the body and chronic rhinosinusitis. While the exact connections are still not fully understood, scientists are investigating how these factors might contribute to the development or worsening of CRS. Ongoing studies aim to uncover more about their impact and how they might influence treatment options for those affected by the condition.
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The inflammation of the nasal and sinus mucosa in chronic rhinosinusitis (CRS) leads to an overproduction of nasal mucus. This causes patients to experience a sensation of fullness in the nose, along with the dripping of excess mucus, either out of the nose or down into the throat. This excessive mucus buildup is one of the hallmark symptoms of CRS, contributing to discomfort and difficulty breathing.
Post-nasal drip occurs when mucus from the nose runs down the back of your throat. Normally, your nose produces around 500 ml of mucus a day, which flows down to the throat in small droplets that you swallow unconsciously.
However, with post-nasal drip, this process becomes noticeable. You may feel mucus building up in your throat, causing the urge to swallow or clear your throat often. The sensation can be persistent, making it feel like the mucus won’t clear no matter what you do.
For people who have had sinus surgery, the problem can worsen as mucus may accumulate in the sinuses and drain later. CRS-induced inflammation leads to excess mucus production, which exacerbates the post-nasal drip feeling.
Using a saline rinse can help flush out the mucus, reducing the uncomfortable feeling and making it easier to manage the symptoms.
Nasal blockage occurs when the inner lining of the nose and sinuses becomes swollen or when nasal polyps (soft, non-cancerous growths) obstruct the airflow. Mucus buildup and crusting inside the nose can also make it difficult to breathe through your nose.
One effective way to alleviate nasal blockage is by rinsing your nose with saline. This helps to reduce swelling, clear out mucus and crusts, and improve airflow, making it easier to breathe. Regular nasal irrigation can provide significant relief for those suffering from nasal congestion due to CRS.
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Headache or facial pressure/pain is a common symptom of chronic rhinosinusitis (CRS). However, if headache or facial pressure/pain is your only symptom and you don’t have nasal blockage or mucus production, it’s less likely to be caused by CRS.
When related to CRS, headaches typically occur along with other symptoms like nasal blockage or a runny nose. Sinus headaches often feel like a dull, constant pressure around the eyes or forehead. Headaches occurring on the sides of your head or in your neck are rarely linked to sinus issues.
To confirm whether your headache is related to CRS, an ENT (ear, nose, and throat) doctor can perform a nasal endoscopy to examine your nasal passages and sinuses. A CT scan may also be ordered to get a clearer view of any sinus involvement.
There isn’t a specific test like a blood test or scan to directly measure headaches. Instead, doctors rely on asking questions to gather key information about your symptoms. These questions typically focus on:
This detailed information helps your doctor understand the pattern and possible cause of your headache, which is crucial for an accurate diagnosis and treatment plan.
If headache or facial pain is your only symptom, and it doesn’t improve with sinus treatments, it is less likely to be caused by sinus issues. In such cases, it may be necessary to consult a neurologist to investigate other potential causes. Here are some additional reasons to consider seeing a neurologist:
These symptoms are more commonly associated with neurological conditions, and a neurologist will be able to perform further assessments to help determine the underlying cause and recommend appropriate treatment.
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When you smell something, tiny particles from the air travel to the upper part of your nose, where they interact with special cells called receptors in the olfactory mucosa. This area is located high up inside the nose and is responsible for detecting scents.
In chronic rhinosinusitis (CRS), particularly when nasal polyps are present, inflammation can affect the olfactory mucosa, reducing your ability to smell. Additionally, large polyps can physically block odours from reaching the smell receptors, making it even harder to detect scents. This results in a reduced or lost sense of smell, a common symptom in individuals with CRS and nasal polyps.
Even after surgery to remove nasal polyps, the inflammation in the olfactory mucosa (the smell region) caused by CRS can persist. This ongoing inflammation may continue to affect your sense of smell.
To help improve this, it is important to continue using corticosteroid nasal sprays daily or biologics as prescribed by your doctor, as they help reduce inflammation in the smell area. In some cases, corticosteroid tablets like prednisolone may temporarily improve your sense of smell, but they are generally used for short periods due to their potential side effects. Keeping up with prescribed treatments is key to managing CRS-related smell issues.
Both medical and surgical treatments aim to reduce inflammation in the nose and sinuses, which can help restore your sense of smell.
Medical Treatments:
Surgical Treatments:
However, it’s important to note that predicting the level of improvement after surgery can be challenging. While studies show that surgery can have a positive effect, the benefits may diminish if nasal medications are stopped afterwards. For long-term results, continuing with prescribed treatments (such as nasal sprays) is often necessary to maintain any improvements in smell.
Your sense of smell plays a big role in how you experience taste. When you eat, tiny particles from the food travel through a passage that connects your throat to your nose. This allows your smell receptors to enhance the flavours, making food taste more vibrant.
If your sense of smell is reduced (as in conditions like CRS), your ability to taste food can also be affected. A simple experiment you can try is to pinch your nose while eating. You’ll notice how much harder it is to taste food because the aromas that enhance flavour can’t reach your smell receptors properly. This is why a loss of smell can often lead to a diminished sense of taste.
The main cause of smell loss in CRS is not just the blocked airways caused by swollen tissue or polyps, but rather the chronic inflammation of the olfactory mucosa (the area responsible for your sense of smell). This ongoing inflammation can impair the functioning of smell receptors, leading to a reduced ability to detect odours.
Corticosteroid nasal sprays and biologics reduce this inflammation and often help improve the sense of smell. However, if the olfactory mucosa has been significantly damaged over time, it may not fully recover, meaning your sense of smell might not return to normal levels, even with treatment.
Yes, you’re right—CRS and COVID-19 cause smell loss through different mechanisms.
In many cases, smell loss from COVID-19 improves within a few weeks to months as the body recovers. However, if you’re experiencing this, it’s important to speak with a healthcare provider to rule out other possible causes and get proper guidance.
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Yes, CRS can impact sleep quality. When the nose is blocked due to inflammation, swelling, or polyps, it forces people to breathe through their mouth, which can disrupt sleep and cause discomfort. The buildup of mucus can also be bothersome during the night, further preventing restful sleep.
Additionally, because sleep is crucial for recovery, the poor quality sleep caused by CRS can lead to a cycle of fatigue, making it harder to manage CRS symptoms during the day.
Managing symptoms, such as using saline rinses, corticosteroid nasal sprays, or addressing any underlying allergies, can help with nasal congestion and potentially improve sleep quality. If sleep issues continue, it may be helpful to talk to a healthcare provider for advice on treatment options and ways to promote better rest.
Yes, CRS can contribute to snoring and obstructive sleep apnea (OSA). When the nasal passages are blocked due to inflammation or polyps, it can make breathing through the nose difficult, which often leads to snoring. In more severe cases, it can contribute to sleep apnea by causing the airways to become partially or completely obstructed during sleep, leading to pauses in breathing.
Surgery, such as sinus surgery, may help by reducing nasal obstruction, removing polyps, or improving airflow. This could, in turn, reduce snoring and improve symptoms of obstructive sleep apnea. However, whether surgery is appropriate depends on the severity of the nasal obstruction and how much it is contributing to the sleep issues.
Your ENT doctor will be able to evaluate your condition and discuss potential treatments, including surgery, if necessary, to help improve both your sinus health and sleep quality. For some, other treatments like CPAP therapy for sleep apnea or using nasal strips to open the nose might also be recommended alongside sinus treatments.
CRS can affect your ability to work in two ways:
On average, people with CRS miss about 6 workdays a year. In addition, nasal symptoms like congestion, poor sleep, fatigue, and trouble concentrating can make it harder to focus and get work done, reducing overall productivity.
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The nose, sinuses, and lungs are all connected and affect each other. When CRS is not well-controlled, it can make asthma worse, and asthma can also worsen rhinosinusitis symptoms. Studies show that people with both conditions often have a weaker immune defence against viral infections, which may explain why they catch colds more frequently and why those colds last longer.
Yes, CRS can lead to a chronic cough. The exact mechanism is not clear, being more complicated than mucus dripping in the throat. It is also important to test for asthma, as some coughs are caused by a type of asthma called cough-variant asthma.
The nose and sinuses (upper airways) and the lungs (lower airways) are closely connected. Many people with asthma also have CRS, and the more severe the asthma, the more likely it is to have rhinosinusitis, with up to 80% of severe asthma patients having CRS. Either condition can develop first, but both need to be treated together for the best results.
Asthma is common in people with CRS, especially if they also have nasal polyps. Untreated asthma can make it harder to manage rhinosinusitis, and both conditions often require combined treatment. Especially when tablets or injections are used avoidance of overdosing or side effects is important.
When CRS is not treated, it can worsen asthma symptoms and make it harder to control. Proper treatment of rhinosinusitis can improve asthma control, reduce symptoms, and even lower the need for strong asthma medications.
Some people with asthma, nasal polyps, and respiratory reactions to aspirin have a condition called aspirin-exacerbated respiratory disease (N-ERD), also known as Samter’s triad. About 9% of adults with asthma and 30% of adults with both asthma and nasal polyps have N-ERD.
N-ERD is not caused by taking aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs), but these medications can trigger or worsen asthma and sinus symptoms. The exact cause of N-ERD is unknown, and it does not appear to be inherited.
Rhinitis (inflammation inside the nose), sinusitis (inflammation inside the sinuses) and asthma (inflammation inside the lower airways and lungs) are conditions that often coexist and can make each other worse. The nose is the air conditioner of the body and when you breathe through your nose the air is humidified and cleaned. Nasal obstruction leads to mouth breathing and the reduction of this important air conditioning function. The inflammation in the nose, sinus and lungs influence each other via the bloodstream.
Current evidence suggests that CRS does not make COVID-19 more severe. However, it is important to stay alert for COVID-19 symptoms like loss of smell, cold- or flu-like symptoms, fever, or trouble breathing. Keeping your CRS well-controlled with treatment and following your doctor’s advice is the best way to manage your overall health.
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