Conditions of the Nose and Paranasal Sinuses » Nasal Polyps
Definition ≡ Edematous masses in nose (usually from ethmoid sinuses)
Incidence
- More common than you think
- Adults
- If present in child <10 y/o: rule out cystic fibrosis
Etiology
Unknown, but associated with:
- Allergy
- Chronic sinusitis
- Cystic fibrosis
- ASA sensitivity triad – Asthma, nasal polyps, and aspirin sensitivity (leads to broncho-constriction
Clinical Findings
Symptoms
- Nasal obstruction
- Decreased smell sense
- Anterior watery rhinorrhea
Signs
- Nasal polyps
- Hyponasal voice
- Chronic sinusitis
Diagnosis
- History
- Exam- nasal speculum (+ headlight/mirror), indirect nasopharyngoscopy
- Biopsy (rule out cancer) if unilateral or not “edematous” polyp
- ENT referral, Sinonasal endoscopy
- Imaging – plain sinus x-rays, CT scan
Treatment
- Nasal saline rinses
- Topical nasal steroid spray
- Treat chronic sinusitis if symptoms
- Endoscopic sinus surgery
Complications
- Sinusitis (and it’s complications)
- Permanent loss of smell
- Inverting papilloma
Prognosis
“Polyps are like weeds”. Difficult to eradicate completely. Aim of management is, therefore, control of symptoms.
