creation date: 2026-05-04 22:32
tags: Pathologies
Nasal Polyps
Background
Definitions
Nasal polyps are benign, inflammatory, hyperplastic outgrowths of the sinonasal mucosa.
Etiology
Nasal polyps are commonly associated with chronic rhinosinusiti. Other associated conditions include aspirin-exacerbated respiratory disease, some systemic vasculitides, and cystic fibrosis.
Pathogenesis
In Western populations, the primary mechanism is a type 2 inflammation with eosinophilia and elevated IgE.
The pathophysiology is varied but involves multiple age-related changes that promote stasis of thick mucus:
- Decrease in ciliary beat frequency
- Atrophy of sinonasal mucosa with reduced vasculature
- Diminished mucus secretion
These changes impair the clearance of irritants and pathogens (eg. viruses, bacteria, fungi) and contribute to increased epithelial basement membrane permeability.
Resultant edema and chronic inflammation causes increase in cell and tissue size.
Clinical Presentation
Signs & Symptoms
Symptoms vary based on the etiology. Presentations vary from asymptomatic to severely impaired quality of life.
Cardinal symptoms of chronic rhinosinusitis, which is the most common associated condition, are:
- Progressive nasal obstruction
- Nasal or facial congestion
- Rhinorrhea
- Decreased sense of smell
Visualization of the polyps will reveal mobile, smooth, grey, and semi-transclucent masses originating from the middle meatus or sphenoethmoid recess.
They are generally bilateral (inflammatory polyps) and unilateral polyps should raise suspicion for alternative etiology or malignancy.
History & Physical Exam
Other medical conditions that may be associated that should be asked about are:
- Sensitivity to aspirin or NSAIDs
- Asthma
- Epistaxis
- Chronic otitis media
- Recurrent bronchitis
- Pneumonia
Physical exam includes anterior rhinoscopy.
Risk Factors
Diagnosis
Criteria
Diagnosis is made clinically based on anterior rhinoscopy or nasal endoscopy.
Work-up
Further workup is not necessary in classic cases (chronic rhinosinusitis with nasal polyps).
Patients who do not improve with therapy or have atypical presentation will need further workup with a PNS CT scan and referral to ENT.
Differential
Other diagnoses include:
- Antrochoanal polyps
- Papillomas
- Malignancy
- Nasal duct cysts
Red Flags / Complications
Suspicion should be raised if:
- Unilateral polyp (refer to ENT for biopsy)
Management
Initial Treatment
Patients with nasal polyps originating from chronic rhinosinusitis are treated with:
- Intranasal corticosteroids
- Nasal saline irrigations
Therapy is attempted for 2-3 months to alleviate symptoms and reduce polyp size.
In cases where systemic disease is associated with nasal polyps, treatment of underlying disease is essential.
Refractory Cases
Should the condition not improve, a referral to ENT is indicated for:
- Functional endoscopic sinus surgery
- Oral corticosteroids
- Biologics