Chronic sinusitis with nasal polyps: A young man presents with one year of severe, worsening nasal congestion, smell loss, and thick nasal discharge. He was placed on nasal steroids by his PCP but hasn’t had significant improvement. Nasal endoscopy demonstrates nasal polyps filling the nasal cavity, CT scan of the sinuses shows near-complete sinus opacification, and allergy skin prick testing demonstrates multiple inhalant sensitizations to perennial allergens.

• This patient has chronic sinusitis with nasal polyps. There is a variable amount of concurrent allergen sensitization in this group
• There is no evidence for treatment of polyps with immunotherapy alone, but treatment of allergy in conjunction with standard treatments for nasal polyps (steroids, endoscopic sinus surgery), may be beneficial in alleviating some of his symptoms

Central compartment atopic disease: A young man presents with one year of severe, worsening nasal congestion. His sense of smell is generally intact, and he copious clear, thin secretions. Nasal steroids are somewhat helpful in mitigating his symptoms, but he still has bothersome symptoms and would like to do more. Nasal endoscopy demonstrates polypoid middle turbinates obstructing the middle meatus, CT scan of the sinuses shows opacification of the central part of the nasal cavity and middle meatus but sparing of the maxillary sinus walls, lamina and skull base, and allergy skin prick testing demonstrates multiple inhalant sensitizations to perennial allergens.

• This patient likely has central compartment atopic disease. He has clinical signs of allergic disease with polypoid middle turbinates, and peripheral sparring with central opacification on his CT scan
• Treatment of this bridges between treatment of allergic rhinitis and chronic rhinosinusitis. There is likely a role for surgical management of the central compartment and also for allergic management with immunotherapy

There are numerous scenarios with overlap between chronic rhinosinusitis and allergic rhinitis. Treatment of chronic rhinosinusitis and allergic rhinitis can overlap and be complimentary.