OTITIS (DP SKONER, SECTION EDITOR) Chronic Rhinosinusitis with Nasal Polyps in Older Adults: Clinical Presentation, Pathophysiology, and Comorbidity Woo-Jung Song 1 & Ji-Hyang Lee 1 & Ha-Kyeong Won 2 & Claus Bachert 3 Published online: 5 September 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of Review Chronic rhinosinusitis and nasal polyps (CRSwNP) is a common condition that significantly affects patients’ life. This work aims to provide an up-to-date overview of CRSwNP in older adults, focusing on its aging-related clinical presentations, pathophysiology, and comorbidity associations including asthma. Recent Findings Recent large population-based studies using nasal endoscopy have shown that CRSwNP is a mostly late-onset disease. Age-related changes in physiologic functions, including nasal epithelial barrier dysfunction, may underlie the incidence and different clinical presentations of CRSwNP in older adults. However, there is still a paucity of evidence on the effect of aging on phenotypes and endotypes of CRSwNP. Meanwhile, late-onset asthma is a major comorbid condition in patients with CRSwNP; they frequently present with type 2 inflammatory signatures that are refractory to conventional treatments when they are comorbid. However, as they are more commonly non-atopic, causative factors other than classical atopic sensitization, such as Staphylococcus aureus specific IgE sensitization, are suggested to drive the type 2 inflammation. There are additional comor- bidity associations in older patients with CRSwNP, including those with chronic otitis media and head and neck malignancy. Summary Age is a major determinant for the incidence and clinical presentations of CRSwNP. Given the heterogeneity in phenotypes and endotypes, longitudinal investigations are warranted to elucidate the effects of aging on CRSwNP. Keywords Chronic rhinosinusitis . Nasal polyps . Asthma . Comorbidity . Aging Introduction Chronic rhinosinusitis (CRS) is one of the main chronic conditions in adults, affecting about 10% of the general population [1]. It is defined as chronic inflammation of the nose and paranasal sinuses, characterized by the presence of two or more of the following symptoms for more than 12 weeks: nasal discharge, nasal congestion or obstruction, facial pain or pressure, and reduction or loss of smell [2]. It significantly affects patients’ quality of life, impairing their work productivity and social life [3]. A previous study using the 36-item Short-Form Health Survey report- ed that the effect of CRS on bodily pain and social func- tioning were comparable with or greater than that of other chronic diseases such as congestive heart failure, angina pectoris, chronic obstructive pulmonary diseases, and chronic back pain [4]. CRS is classified into two major subgroups based on endoscopy or computed tomography (CT) findings: CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP) [2]. Nasal polyps are inflammatory outgrowths of sinonasal tissues. They are usually benign but may cause severe nasal obstruction and reduction or loss of smell [5], and are frequently comorbid with se- vere asthma [1]. Of note, CRSwNP is a late-onset disease. A review of medical records of 4986 patients with asthma and rhinitis vis- iting an allergy clinic in the USA showed that the frequency of nasal polyps was significantly higher in patients older than This article is part of the Topical Collection on Otitis * Woo-Jung Song swj0126@amc.seoul.kr 1 Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea 2 Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea 3 Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium Current Allergy and Asthma Reports (2019) 19: 46 https://doi.org/10.1007/s11882-019-0880-4