March 10, 2026 | Black & Kletz Allergy
Chronic rhinosinusitis (i.e., long-standing inflammation of the tissues inside the nasal cavity and sinuses inside the facial bones) is one of the most common medical conditions, affecting approximately 12% of the population. In roughly 20% of these patients, there is an association with nasal polyps and the condition is thus named “chronic rhinosinusitis with nasal polyps.”
Nasal polyps are soft tissue growths that form on the lining of the nasal passages and inside the sinuses (i.e., air-filled cavities within the facial bones). Nasal polyps are painless and non-cancerous. They are usually in the shape of teardrops and glisten like moist grapes. Polyps develop when the mucus membranes are chronically inflamed and swell up over a long period of time.
When the polyps grow large, they can obstruct the nasal passages and cause breathing difficulties. They can also block the free passage of secretions from the sinuses into the nose. This blockage predisposes individuals with nasal polyps to sinus infections.
Any condition which results in chronic inflammation inside the nose and sinuses may lead to polyp formation. Some of these conditions are as follows:
- Allergic rhinitis
- Chronic sinusitis
- Aspirin sensitivity
- Asthma
- Cystic fibrosis
- Eosinophilic disorders
- Allergic fungal sinusitis
Causes:
It is believed that inflammation causes the buildup of fluid within the mucus membranes. This accumulation of fluid results in the formation of fluid-filled growths, which over time expand to become polyps.
Symptoms:
- Nasal congestion
- Runny nose
- Post-nasal drip
- Diminished sense of taste and smell
- Facial pressure/headaches
- Snoring
Diagnosis:
- Endoscopic examination of nose
- Imaging studies such as Xrays and CT scans
- Allergy tests
- Sweat chloride test for cystic fibrosis
- Eosinophil count in the peripheral blood
- Measurement of biomarkers such as periostin
Complication:
- Long-term (i.e., chronic sinusitis) or repeated sinus infections
- Nosebleeds (i.e., epistaxis)
- Asthma exacerbations
- Obstructive sleep apnea
- Double vision (i.e., diplopia)
Treatment:
Corticosteroid nasal sprays are the usual first line of management. Large volume nasal steroid (e.g., budesonide) rinses with squeeze plastic bottles have been shown to be superior to traditional steroid sprays.
Exhalation delivery system with fluticasone (i.e., Xhance) is a recently approved steroid device that sprays the corticosteroid fluticasone deeper into the nasal cavity in order to reduce inflammation from nasal polyps. The patient actually blows into one end of the device which ironically forces the corticosteroid medication deep into the nasal cavity allowing more medication to reach the target.
Decongestant medications are sometimes helpful to shrink the size of the nasal polyps. Antibiotics may be needed in cases of bacterial sinus infections.
Montelukast (i.e., Singulair), an oral anti-inflammatory drug leukotriene antagonist, has been shown to reduce the size of polyps in some patients with chronic rhinosinusitis with nasal polyps.
If the nasal polyps continue to grow in spite of the use of nasal sprays and oral medications, especially if they are blocking the nasal passages, they may need to be surgically removed.
If the underlying causes such as allergies and aspirin sensitivity remain untreated, nasal polyps have a tendency to recur a few months or years after surgical removal. Some studies have demonstrated that the regular use of corticosteroid nasal sprays may reduce the chances of polyp regrowth after surgery.
Biologic medications such as dupilumab, mepolizumab, tezepelumab, and omalizumab which have been approved to treat moderate to severe asthma, have also gained approval to treat chronic rhinosinusitis with nasal polyps. These medications are given as injections every 2-4 weeks and have been shown to reduce the need for surgery and treatment with oral corticosteroids.
Prevention:
Aggressive treatment of predisposing conditions such as allergic rhinitis (i.e., hay fever) with a combination of environmental controls, medications, and desensitization procedure (i.e., allergy shots, allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) may inhibit nasal polyp formation. Avoiding exposure to smoke, strong odors, and chemical sprays is important in order to reduce nasal irritation and excessive tissue growth.
Patients with established chronic sinusitis may require antibiotics, nasal/sinus irrigations, and/or sinus surgery. Individuals with a history of aspirin sensitivity should do better after desensitization to aspirin in terms of better asthma control and reduction in relapses of nasal polyps.
The board certified allergists at Black & Kletz Allergy have been diagnosing and treating chronic rhinosinusitis with nasal polyps for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Our Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. The allergy specialists at Black & Kletz Allergy are extremely knowledgeable about the most current treatment options for patients with this condition as well as with allergic rhinitis, allergic conjunctivitis (i.e., eye allergies), asthma, sinusitis, food allergies, insect sting venom allergies, medication allergies, hives (i.e., urticaria), generalized itching (i.e., pruritus), eczema (i.e., atopic dermatitis), eosinophilic esophagitis, mast cell activation syndrome, and immune disorders and can promptly answer any of your questions. To schedule an appointment, please call any of our offices or you may click Request an Appointment, and we will respond within 24 hours by the next business day. We have been servicing the greater Washington, DC area for more than 5 decades and we look forward to providing you with exceptional state-of-the-art allergy and asthma care in a welcoming and friendly environment.
