Nasal polyp

Background

  • Benign masses filled with inflammatory material that may form in the nasal cavity or paranasal sinuses
  • Can be associated with cystic fibrosis in children [1]

Clinical Features

  • Nasal airway congestion or obstruction
  • Thick nasal discharge
  • Anosmia
  • May present in patients with chronic rhinosinusitis, asthma, and aspirin sensitivity (in the syndrome of aspirin-exacerbated respiratory disease)

Differential Diagnosis

  • Choanal atresia
  • Mucocele
  • Deviated or dislocated nasal septum
  • Hematoma
  • Chordoma
  • Isolated piriform aperture stenosis
  • Nasal dermoid
  • Nasolacrimal duct cyst
  • Turbinate hypertrophy

Evaluation

  • Physical exam with a nasal speculum or rhinoscope
  • Appear as gray, glistening masses
  • May also be visualized on CT imaging

Management

  • Intranasal glucocorticoids are preferred [2]
  • Oral glucocorticoids should only be used in severe or refractory cases
  • Consider treatment of underlying allergies, antileukotriene agents, and daily saline lavage of the sinuses
  • Individuals who fail medical therapy should be considered for surgery
    • Surgery may only offer temporary relief as polyps tend to recur after surgery alone
    • Continued medical therapy should follow surgery [3]

Disposition

  • Discharge, outpatient follow up


References

  1. Ramsey B, Richardson MA. Impact of sinusitis in cystic fibrosis. J Allergy Clin Immunol. 1992;90(3 Pt 2):547-552. doi:10.1016/0091-6749(92)90183-3
  2. Newton JR, Ah-See KW. A review of nasal polyposis. Ther Clin Risk Manag. 2008;4(2):507-512. doi:10.2147/tcrm.s2379
  3. DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2017;127(3):550-555. doi:10.1002/lary.26391
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