Dr. Ameen, ENT Specialist in Kuala Lumpur

PART 2 – CRS With Polyps vs Without Polyps: Why the Difference Matters

Not all chronic sinus problems behave the same. One of the most important distinctions we make as ENT specialists is whether CRS occurs with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP).

Why does this matter?

Because these two types behave differently, respond differently to treatment, and even have different immune pathways.

CRS Without Nasal Polyps (CRSsNP)

This form often presents with:

• Facial pain or pressure
• Thick mucus
• Nasal blockage
• Normal-looking nasal cavity on first glance

Inflammation here tends to be more localized and often associated with:

• Structural issues (deviated septum)
• Dental sinus infections
• Recurrent acute infections

CRS With Nasal Polyps (CRSwNP)

Nasal polyps are soft, painless, grape-like swellings arising from chronically inflamed sinus lining. They’re not tumours — but they can behave aggressively.

Patients often complain of:

• Severe nasal blockage
• Loss of smell (sometimes complete)
• Constant watery or thick discharge
• Symptoms that return quickly after stopping medications

CRSwNP is typically driven by Type 2 inflammation, involving eosinophils, IgE, and cytokines like IL-4, IL-5, and IL-13 — the same pathway seen in asthma and eczema.

This explains why CRS with polyps often coexists with:

• Asthma
• Aspirin-exacerbated respiratory disease (AERD)
• Allergic tendencies

Different disease, different biology — and therefore, different strategies.