Chronic Rhinosinusitis without Nasal Polyps

Abstract

Chronic rhinosinusitis without nasal polyps (CRSsNP) is more prevalent than chronic rhinosinusitis with nasal polyps (CRSwNP). Certain diseases predispose to whereas others are associated with CRSsNP. Predisposing diseases include allergic and non-allergic upper and lower airway diseases, epithelial cell disorders, immunodeficiencies, autoimmune diseases, and some infectious diseases. Additionally, environmental and host factors, examples of which include smoking, a higher incidence of abnormal biofilms, and innate immune defects play a role in the pathogenesis of this disease. CRSsNP is characterized by histologic abnormalities, including basement membrane thickening (fibrosis) and goblet cell hyperplasia. Neutrophils and several chemokines, TGF-β and CXCL-8, play a role in CRSsNP remodeling. However, there are conflicting data about CRSsNP endotypes, e.g., whether it is characterized by neutrophilia or eosinophilia or both. In spite of advancements and the understanding of the pathogenesis of this disease, additional study is necessary to better comprehend its underlying mechanisms, endotypes, and evidence based treatment strategies.

Phase 1 clinical study to assess the safety of a novel drug delivery system providing long‐term topical steroid therapy for chronic rhinosinusitis

“…CRS phenotypes can be divided into CRSwNP and CRSsNP based on the presence or absence of nasal polyps via endoscopic findings. Epidemiologic studies across geographic regions indicate CRSsNP is more prevalent in all ages than CRSwNP . However, available topical steroid therapies are only indicated for nasal polyps.…”

Evolution in the surgical management of chronic rhinosinusitis: Current indications and pitfalls

“…11 CRSsNP is characterized mostly by fibrosis and neutrophilic inflammation, as well as by T H 1 or T H 17 responses. 12 CRSwNP (Fig 1) is associated with moderate or severe T H 2 eosinophilic inflammation and comorbid asthma. However, several studies in recent years have suggested that the molecular diversity in CRS pathogenesis is more complex and that this classification might not be sufficient.…”

Do Adult Forms of Chronic Rhinosinusitis Exist in Children and Adolescents?

“…Individual manuscripts on the theme issue include findings that the presence of polyps raises the specter of CF [4,5] but CRS without polyps raises no pediatric discussion [6]. The authors of the manuscripts about infectious CRS and AERD provided no pediatric perspective [7,8], but children are briefly mentioned in a section of other phenotypes [5].…”

“…A condition of adult CRS without polyps appears to exist [6]. However, its presence as a distinct pediatric entity is non-existent in the literature.…”