Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the sinonasal mucosa characterised by bilateral polyp growth, persistent nasal obstruction, anosmia, and impaired quality of life. Driven predominantly by type 2 inflammation — with IL-4, IL-5, IL-13, and IgE as key mediators — CRSwNP affects 1–4% of the general population and 20–30% of all chronic rhinosinusitis patients.
8 key symptoms and signs
| Feature | Frequency | Category | Sources |
|---|---|---|---|
Nasal obstruction/congestion Bilateral nasal blockage, often progressive and unresponsive to decongestants. Worse on lying down. Most bothersome symptom reported by patients. | 95% | sinonasal | |
Anosmia/hyposmia Loss or reduction of smell is a hallmark feature, often the earliest and most distressing symptom. Strongly correlates with eosinophilic inflammation and polyp burden. May persist after surgery without biologic therapy. | 85% | sinonasal | |
Anterior/posterior rhinorrhea Thick, mucopurulent or clear nasal discharge. Posterior nasal drip causes throat clearing and cough. | 80% | sinonasal | |
Facial pain/pressure Dull pressure over cheeks, forehead, or between eyes. Less prominent in CRSwNP than in CRS without polyps. | 60% | sinonasal | |
Impaired quality of life SNOT-22 scores significantly elevated. Sleep disturbance, fatigue, and reduced productivity. Impact comparable to COPD and heart failure. | 90% | systemic | |
Taste dysfunction Closely linked to anosmia. Reduced flavour perception significantly impacts nutrition and quality of life. | 70% | sinonasal | |
Sleep disturbance Mouth breathing, snoring, and obstructive sleep apnoea secondary to nasal obstruction. | 75% | systemic | |
Blood eosinophilia Peripheral blood eosinophils >300 cells/μL in majority of patients. Correlates with disease severity and recurrence risk. | 70% | laboratory |
Competing explanations ranked by evidence weight