Chronic Sinusitis and Nasal Polyps: Diagnosis and Treatment
Published September 2019
Collaborative Care Expands Nonsurgical Treatment Options
Each year, more than 30 million individuals are diagnosed with sinusitis in the U.S. Up to 10 percent of the population has chronic rhinosinusitis, also called chronic sinusitis, which is persistent sinus inflammation. Northwestern Medicine Otolaryngologist Robert C. Kern, MD, who is also a head and neck surgeon, discusses the evolving treatment options available.
Chronic Sinusitis and Polyps
Sinusitis occurs when your sinuses have become inflamed and infected as a result of fluid being trapped, allowing germs to grow. If symptoms persist for more than 12 weeks, you may have chronic sinusitis. In addition, 1 to 2 percent of the population may have nasal polyps, which are growths that can occur in your nasal passageways or sinuses if inflammation persists. Dr. Kern likens them to weeds.
“They will grow back, so specific treatment is available to address this problem,” he says. Dr. Kern sees patients at the Sinus and Allergy Center of Northwestern University at Northwestern Memorial Hospital, where patients have access to a multidisciplinary team. “Here, we use leading-edge treatment and work very closely with allergists to provide comprehensive care.”
Treatment – and Antibiotic Overuse
Antibiotics are often the first line of defense to treat sinus infections. Unfortunately, according to a study by the CDC, antibiotics for sinus infections are usually misused or prescribed for too long. Nine out of 10 cases are caused by a virus, which can’t be treated with antibiotics.
“Antibiotics kill bacteria, but most of these cases do not actually require antibiotics,” explains Dr. Kern. “This results in overuse. Most don’t benefit from this type of treatment.”
Additionally, misdiagnosis or self-care tactics may prevent or prolong healing. For example, taking antihistamines can thicken mucus, exacerbating symptoms. Instead, it’s important to understand the cause of the issue.
“We need to understand what kind of inflammation is occurring. Then, we can better identify what products can help provide relief,” says Dr. Kern.
Nonsurgical Treatment Options
XHANCE, the only FDA-approved prescription nasal spray, can be used daily to treat nasal polyps. The spray delivers medicine deep into your nasal passages, addressing the source directly. Clinical trials have shown reduced nasal congestion and nasal polyps.
“These are steroids, so this type of treatment may not be right for everyone,” cautions Dr. Kern. Additionally, the FDA has approved Dupixent (dupilumab) to treat chronic rhinosinusitis with nasal polyps. This medication is given as an injection, which can help patients avoid surgery.
Surgical Treatment for Sinus Conditions
In cases that are resistant to other types of treatment, surgical procedures may be pursued to help you breathe easier. Your physician will determine the source of the disruption to identify the appropriate treatment for you.
Options may include:
- Traditional sinus surgery, which entails the removal of diseased sinus tissue to help improve drainage.
- Minimally invasive balloon sinuplasty, which expands the natural drainage openings of the passages.
- A sinus implant called SINUVATM, which can help you breathe easier and may be an option for adults who have previously had endoscopic sinus surgery. This implant is designed to open in the sinus cavity to deliver anti-inflammatory medicine (mometasone furoate) over a 90-day period. The implant is proven to shrink nasal polyps and reduce sinus obstruction, resulting in improved sense of smell. The treatment can be done in an outpatient setting and typically requires minimal anesthesia.
Leading-Edge Sinus Care
In partnership with the Division of Allergy and Immunology, Northwestern Medicine Otolaryngology received an $8.4 million research grant from the National Institutes of Health (NIH) to study all aspects of chronic rhinosinusitis. This collaboration may pave the way for new, innovative treatments.
With so many treatment options, it’s important to have a collaborative team to develop a treatment plan that meets your individual needs, says Dr. Kern. “Our whole team works together to individualize your treatment,” he explains. “We provide a complete, state-of-the-art evaluation and are undergoing extensive research in this field. It’s a truly talented team.”