What are nasal polyps?
Benign swellings of the mucosal lining of the paranasal sinuses.
What risk factors for nasal polyps?
- Asthma
- Eosinophilic granulomatous polyangiitis (EGPA, also known as Churg-Strauss syndrome)
- Allergic fungal rhinosinusitis (AFRS)
- Aspirin sensitivity
What are the signs of nasal polyps?
- Direct visualisation
What are the symptoms of nasal polyps?
- Nasal obstruction
- Nasal discharge
- Facial pain and pressure
- Reduces sense of taste and smell
Briefly describe the composition of nasal polyps
- Mixture of loose connective tissue, oedema, inflammatory cells (mostly eosinophils), glandular cells, and capillaries.
- Polyps are covered with varying types of epithelium, mostly respiratory pseudostratified epithelium with ciliated cells and goblet cells.
Which condition is nasal polyps commonly seen in?
Chronic rhinosinusitis
What investigations should be ordered for nasal polyps?
- Anterior rhinoscopy
- Nasal endoscopy
Why investigate using anterior rhinoscopy? And what may this show?
- Visualisation is essential for a diagnosis of nasal polyps to be made.
- Polyps visualised.
Why investigate using nasal endoscopy? And what may this show?
- May be required if polyps not seen on anterior rhinoscopy. Visualisation is essential for a diagnosis of NP to be made.
- Polyps visualised.
When is CT imgaging and biopsy indicated for nasal polyps? And why?
Unilateral polyps are suspicious of a neoplasm and are investigated with CT imaging and biopsy.
Briefly describe the treatment of nasal polyps
- Intranasal corticosteroid
- Nasal saline irrigation
- Doxycycline
- Surgical polypectomy
When is surgical polypectomy indicated?
If there is no or minimal improvement in symptoms after the initial 3 months of medical treatment, many clinicians suggest surgery to remove the polyps.
What complications are associated with nasal polyps?
- Periorbital and orbital cellulitis
- Cavernous sinus thrombosis
- Osteomyelitis
What differentials should be considered for nasal polyps?
- Neoplasm
- Congenital lesions (e.g. encephalocele or concha bullosa)
- Foreign body
How does nasal polyps and neoplasm differ?
- Signs and symptoms: features that may suggest neoplasm include unilateral symptoms, epistaxis/bleeding, crusting, cacosmia (perception of foul odour), periorbital oedema, displaced globe, double or reduced vision, ophthalmoplegia, severe frontal headaches, frontal swelling, signs of meningitis or focal neurology, and systemic symptoms such as weight loss.
- Investigations: CT head defines extent and characteristics of the lesion(s). MRI can be performed in conjunction with CT for further evaluation. Biopsy confirms histology.
Investigations:
How does nasal polyps and congenital lesions (e.g. encephalocele and concha bullosa) differ?
- Signs and symptoms: concha bullosa is often asymptomatic, but may cause sinus obstruction. Encephalocoele symptoms are dependent on size and location.
- Investigations: CT and MRI head defines extent and characteristics of the lesion(s).
How does nasal polyps and foreign body differ?
- Signs and symptoms: usually sudden onset of unilateral symptoms. Epistaxis may feature.
- Investigations: nasendoscopy may allow identification and possible retrieval of foreign body.
