Chronic Nonallergic Rhinosinusitis Associated With Military Burn Pit Exposure

Millions of previously deployed individuals nationwide have been affected by military toxic exposures and could be predisposed to a variety of associated health conditions. We present a case of a 38-year-old veteran with chronic rhinosinusitis with nasal polyps (CRSwNP) for two years and explore its possible association with burn pit exposure. He had a history of military burn pit exposure during his deployments to Iraq and Afghanistan, which spanned a total of 20 months. Physical examination revealed pale and enlarged inferior nasal turbinates. CT of the sinuses revealed pansinus mucosal thickening and polypoid tissue. Serologic testing for environmental allergies was negative. Flexible laryngoscopy revealed right nasal polyps. His presentation was consistent with a diagnosis of chronic nonallergic rhinosinusitis with nasal polyps. He was treated with fluticasone and ipratropium intranasal sprays, oral antihistamines, and saline sinus irrigations. Symptom control fluctuated during periods of nonadherence. He required a course of prednisone and intermittent courses of budesonide sinus irrigations. At the one-year follow-up, he had an excellent treatment response on intranasal sprays and intermittent budesonide sinus irrigations. Enhanced awareness of the impact of toxic exposures on previously deployed individuals' health may help improve their quality of life.