Chronic Rhinosinusitis (CRS)
Chronic Rhinosinusitis (CRS) when the spaces inside the nose and head (the sinuses) are swollen and inflamed for three months or longer. It can occur with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP).
CRS is a relatively common condition. It typically affects about 11% of the population¹. It is the most common, and most treatable, cause of smell loss. Studies suggest that up to 60% of cases of smell loss are due to CRS.
CRS can be a very challenging condition to live with. SmellTaste is campaigning for better access to treatment for people with CRS. You can read more about our campaign and how to get involved on our website here.
What are the causes of CRS?
We don’t really know why CRS occurs. It may be one, or all, of the following:
• having lots of colds over time
• an allergic response to toxins
• an upset in the balance between “good” and “bad” germs in the nose
• In a small number of cases this may be linked to being sensitive to anti-inflammatory medicines like aspirin or ibuprofen. This is called NSAID-Exacerbated Respiratory Disease (NERD). It was formerly called Samter’s triad and is known in the US as Aspirin-Exacerbated Respiratory Disease (AERD).
• In an even smaller number of cases the body reacts too strongly to tiny fungi (spores) in the air. This is called allergic fungal rhinosinusitis.
What are the symptoms of CRS?
For a diagnosis of CRS symptoms must include:
• a blocked nose and/or nasal discharge, which is typically thick, discoloured, and may include drainage down the back of the throat (postnasal drainage) which may be associated with a cough
• facial pain or pressure and / or a reduced sense of smell as confirmed by smell/taste testing
In addition, you may feel:
• facial pain or pressure around your cheeks, eyes, or forehead. If this occurs without the other symptoms, it is unlikely to be due to sinusitis
• blocked or full ears
• a cough especially at night, when the mucus drips down the back of your throat
• more tired than usual
• mood changes
• that food and drinks don’t smell or taste the same, or that you can’t smell at all
CRS is an inflammatory condition. In some cases, the swelling of the sinus lining bulges to form polyps that fill up the nose and sinuses, making smelling very difficult, if not impossible.
CRS is not considered to be an infective condition. However the lining of the sinuses and nose may become swollen and prevent mucus from draining, causing it to back up and get infected.
CRS can be caused by and lead to:
- Nasal polyps – These tissue growths can block the nasal passages and/or sinuses.
- Deviated nasal septum – the partition between the two sides of the nose may be crooked, narrowing the nasal passages and adding to the effect of the swelling. This may make the symptoms of sinusitis worse; it may also make treatment with rinses and sprays more difficult.
- Allergies such as hay fever – these do not cause CRS but the inflammation that occurs with allergies can make the symptoms worse.
How is CRS managed?
It is usual practice for a GP to treat your condition in the first instance. They might prescribe nasal sprays and share information on things you can do to help manage the symptoms (see below).
If your symptoms last for more than 3 months after starting nasal medications, you can ask your GP to refer you to a local ENT department or to a clinic that treats smell, taste and sinonasal disorders.
The clinic will undertake tests to confirm the diagnosis, followed by furthertreatment as needed.
The consultant may perform any of the following diagnostic tests:
- Looking into your nose (endoscopy):
A thin tube with a fibreoptic light inserted through your nose allows your doctor to see the inside of your nose. - Imaging tests:
Images taken using special x-rays (CT scan) can show details of your sinuses and nasal area. These can help with diagnosing sinusitis and will be needed if sinus surgery is planned. - An allergy test:
If your doctor suspects that allergies might be making your chronic sinusitis worse, they might recommend an allergy skin test or a blood test.
A skin test is safe and quick and can help detect what allergen is responsible for your nasal flare-ups. - Samples from your nasal and sinus discharge (cultures):
Cultures are generally unnecessary for diagnosing chronic sinusitis.
However, when the condition fails to respond to treatment or is worsening, your doctor may swab inside your nose to collect samples that might help determine the cause, such as bacteria or fungi.
For those patients who don’t get enough relief from their symptoms, sinus surgery may be recommended.
Self-management
Sinus rinsing to clear the nose of any blockages and help reduce the swelling and inflammation. This can be particularly effective for people with CRS. You can find out about this simple procedure on our website here.
One of the best things you can do to help yourself is to understand the condition and learn how to self-manage. You can download our information sheet on CRS here.
You may find these videos helpful:
- Chronic Rhinosinusitis (CRS) for patients and professionals with Consultant Rhinologist Isma Iqbal and expert patient Trevor Jones.
- Chronic Rhinosinusitis (CRS) and Allergies with Professor Carl Philpott
Join our CRS patient group
This group is for anyone with CRS, with or without nasal polyps. The purpose of the group is to build community and offer peer support through on-line meetings where you will have the chance to join small discussion groups, share tips, challenges, and personal experiences in a supportive environment. Through these meetings we will also share details with you about any relevant research studies, our ongoing campaign (see below) and other news and information.
If you would like to be kept informed of the meetings arranged by the CRS group click here.
SmellTaste’s campaign for people living with Chronic Rhinosinusitis (CRS)
Some biologic medicines (drugs that work as antibodies to block the pathway that causes swelling) have been proven to be effective in treating Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). At present, people in the UK with severe cases of this condition for whom sinus surgery hasn’t helped are being denied access to these drugs. This is because the National Institute for Health and Care Excellence (NICE), the NHS and pharmaceutical companies have been unable to reach an agreement on a price for these drugs to treat CRSwNP, even though they are already being used in the UK to treat other conditions such as asthma.
SmellTaste thinks this is unfair and that the system needs to change. We are committed to working with all relevant stakeholders, including the NHS, NICE, MPs and pharmaceutical companies to help improve access for people living with CRS to treatments that provide lasting relief from symptoms. We know from experience that people power can make a big difference, and that’s why we’re asking you to get involved and help in our fight for change.
You can read more about the campaign here.
The Macro Programme
The MACRO Programme is an NIHR-funded research project focused on identifying the best management for patients with CRS within the NHS. The programme is led by Prof Carl Philpott (a trustee of SmellTaste) and Prof Claire Hopkins. SmellTaste is working closely with the research team, supporting recruitment of patients to the trial and helping disseminate the outcomes of the project. For more information visit https://www.themacroprogramme.org.uk/welcome-macro-programme.
The DUET Study
SmellTaste is working with global healthcare company Sanofi who are working with adults with CRSwNP as part of their clinical studies. Recruitment for the DUET Study has now closed. Details of another study will be made available soon.
European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)
SmellTaste is pleased to be working with EUFOREA, an international non-profit organisation. EUFOREA is working to prevent and treat allergies and airway diseases (asthma, rhinitis, and rhinosinusitis) by sharing research and teaching healthcare workers the best care.
References
- Chronic rhinosinusitis in Europe – an underestimated disease http://www.ncbi.nlm.nih.gov/pubmed/21605125