Patient handout

Chronic rhinosinusitis (CRSsNP vs CRSwNP, biologic-era ladder, EPOS 2020 / AAO-HNS 2015)

PRODUCTION

1. Your condition

This handout is for chronic rhinosinusitis (crssnp vs crswnp, biologic-era ladder, epos 2020 / aao-hns 2015). Your care team identified this based on: nasal obstruction / nasal discharge persisting ≥12 weeks (± facial pain/pressure, hyposmia/anosmia) — the dominant crs entry per epos 2020 (fokkens rhinology pmid 32077450) and aao-hns adult sinusitis cpg 2015.

Other reasons your team may use this plan: persistent hyposmia / anosmia ± nasal obstruction — strongly skewed toward crswnp / type-2 phenotype, biologic-eligibility entry (gevaert jaci 2020 pmid 32524991; bachert lancet 2019 pmid 31543428); incidental finding of paranasal-sinus mucosal disease / polyposis on ct or mri in a symptomatic patient — endoscopy + symptom-screen to confirm crs (epos 2020 pmid 32077450); asthma + nasal polyps + nsaid/aspirin hypersensitivity (samter triad / aerd) — recognise then plan dupilumab + aspirin desensitisation (epos 2020 pmid 32077450).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
high_volume_saline_nasal_irrigation_240mL_BID	—	—	—	EPOS 2020 (PMID 32077450) — daily high-volume saline irrigation reduces symptoms and is the indispensable mechanical foundation; superior to low-volume sprays for CRS; safety is excellent
mometasone furoate (intranasal)	2 sprays each nostril (200 mcg total) once daily — or BID in moderate-severe disease	intranasal	once-daily to BID	EPOS 2020 (PMID 32077450) — topical INCS is the central pharmacologic foundation for both CRSsNP and CRSwNP; mometasone or fluticasone are the canonical agents. Counsel correct technique: head-tilt forward, contralateral hand, aim laterally to avoid the septum (lowers epistaxis risk)
fluticasone propionate (intranasal)	2 sprays each nostril (200 mcg total) once daily	intranasal	once daily	EPOS 2020 (PMID 32077450) — interchangeable with mometasone as foundational INCS; minimal systemic absorption

Plan: Chronic rhinosinusitis — phenotype-stepped medical ladder → FESS → biologic for uncontrolled type-2 CRSwNP

3. When to call your provider

Contact your care team if any of the following happen:

Orbital signs (proptosis, vision change, ophthalmoplegia) → emergent IV abx + ENT/ophth, route OUT
Intracranial signs (severe headache, meningismus, focal neuro, Pott puffy tumour) → emergent neurosurg, route OUT
Immunocompromise + sinus invasion + black eschar / palatal ulcer → INVASIVE FUNGAL SINUSITIS, emergent surgical debridement + amphotericin, route OUT
Severe uncontrolled asthma flare in AERD → asthma pathway
Refractory disease despite maximal medical therapy + 1 prior FESS → biologic ladder

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Proptosis / ophthalmoplegia / vision change (orbital extension), OR severe headache + meningismus + focal neuro (intracranial extension), OR Pott puffy tumour (frontal-bone osteomyelitis with subperiosteal abscess) — emergent complications of acute-on-chronic sinusitis (EPOS 2020 PMID 32077450)(life-threatening)
Immunocompromised host (poorly controlled diabetes with DKA, prolonged neutropenia, recent transplant, advanced HIV) with sinus pain + black eschar / palatal ulcer / rapidly evolving sinus signs — INVASIVE FUNGAL SINUSITIS (mucormycosis, invasive Aspergillus) (EPOS 2020 PMID 32077450)(life-threatening)

5. Follow-up

Longitudinal chronic-disease arc: every 3-6 months stable, 4-6 weeks after biologic start / surgery, urgent if uncontrolled flare. Allergy testing + immunotherapy decision for atopic / AFRS. Asthma co-management (CRSwNP and asthma are united-airways; treat in parallel). Smoking cessation. Patient education on irrigation technique + INCS technique (head-tilt, contralateral hand) — adherence is the dominant determinant of medical-ladder success. Pregnancy planning conversation (biologic timing).

6. Sources

Guideline: EPOS 2020 — European Position Paper on Rhinosinusitis and Nasal Polyps (Fokkens et al, Rhinology 2020 PMID 32077450) — the global authority; AAO-HNS Adult Sinusitis CPG 2015 update remains the US algorithm floor. Biologic-era anchors: LIBERTY-NP SINUS-24/52 dupilumab (Bachert Lancet 2019 PMID 31543428), POLYP 1/2 omalizumab (Gevaert JACI 2020 PMID 32524991), SYNAPSE mepolizumab (Han Lancet Respir Med 2021 PMID 33872587). All PMIDs live-PubMed-verified 2026-05-26.