Chronic sinusitis is sinus inflammation that lasts more than twelve weeks despite treatment. Some patients also develop nasal polyps that block airflow and reduce sense of smell. Many patients have spent years on antibiotic and steroid courses without lasting relief. New treatments now address the underlying inflammation directly.
Chronic rhinosinusitis (CRS) is defined by twelve or more weeks of two or more cardinal symptoms — nasal congestion, anterior or posterior drainage, facial pain or pressure, and reduced sense of smell — along with objective evidence of inflammation. CRS exists on a spectrum: some patients have inflammation without polyps (CRSsNP), and others develop nasal polyps (CRSwNP) which often have a more strongly Type 2 inflammatory phenotype.
CRSwNP is increasingly recognized as a chronic immune-mediated disease driven by the same Type 2 inflammatory pathway as severe asthma and atopic dermatitis. This explains why so many patients with nasal polyps also have asthma, eczema, or aspirin sensitivity — and why the new biologic therapies that work for severe asthma also work for nasal polyps.
Diagnosis is based on symptom duration plus objective findings — typically endoscopic visualization or CT imaging when indicated. Evaluation looks for comorbid asthma, aspirin sensitivity, and Type 2 inflammatory markers (eosinophil count, total IgE). Coordination with ENT is common, both for initial diagnostic confirmation and for surgical evaluation when indicated.
Conservative measures are foundational: high-volume saline irrigation, intranasal corticosteroids, and avoidance of irritants. ENT consultation for surgical management is appropriate when polyps are obstructive or when standard therapy is failing.
For patients with CRSwNP that does not respond adequately to conservative measures and surgery, biologic therapy is FDA-approved for the condition. Dupilumab (Dupixent), mepolizumab (Nucala), and omalizumab (Xolair) all have approved CRSwNP indications. Many patients describe meaningful improvement in sense of smell, congestion, and infection frequency. Individual response varies.
A first visit takes a detailed history of your sinus symptoms, prior treatments, and any comorbid asthma or polyp surgery. Coordination with ENT is part of standard care. Biologic candidacy is discussed based on findings and Type 2 markers, and prior authorization is handled in-house.
Donald L. McNeil, MD · Board Certified in Allergy & Immunology and Internal Medicine
This page is provided for educational purposes and does not substitute for clinical judgment or direct medical advice. Treatment decisions are individualized based on your full history, examination, and laboratory findings. If you have an emergency, call 911.