Nasal Polyps

Nasal polyps are benign and edematous growths that usually are multiple, mobile, and bilateral. They may become large and numerous enough to cause nasal distention and enlargement of the bony framework, possibly occluding the airway. Nasal polyps are more common in adults than children and tend to recur.

Causes

It is thought that ongoing (chronic) inflammation in the nose causes overgrowth of the lining of the nostril. This can sometimes lead to small polyps forming. These may then grow larger. Polyps usually affect both nostrils. The cause of the inflammation is unclear in most cases. However, certain conditions make nose inflammation and polyps more likely. These include: asthma, allergy to aspirin, and some rare conditions of the nose.

Signs and Symptoms

Patient history may detail chronic allergic rhinitis, chronic sinusitis, and recurrent nasal infections. The patient may describe nasal obstruction, mouth breathing, sneezing, excessive tearing, watery mucus discharge, loss of smell, a sensation of fullness in the face, a nasal discharge, and shortness of breath.

Inspection of the intranasal area discloses a dry, red surface, with pale, clear, or gray soft growths. Large growths may resemble tumors. In contrast to normal nasal tissue, probing or manipulation doesn't elicit pain when these growths are present.

Diagnostic tests

X-rays of the sinuses and nasal passages reveal soft tissue shadows over the affected areas. Nasal polyps in children require further testing to rule out cystic fibrosis. Immunologic assessment and testing may be considered if allergy is the causative factor. A computed tomography scan may be done to evaluate bone and sinuses.

Treatment

Treatment usually consists of corticosteroids (either by direct injection into the polyps or by local spray) to temporarily reduce the polyp. Treatment of the underlying cause may include antihistamines to control allergy and antibiotic therapy if infection is present. Local application of an astringent shrinks hypertrophied tissue.

Systemic steroids are used with caution in a severely obstructed airway; they may be injected into the polyps. Steroid nasal sprays may be used to reduce inflammation and reduce the polyps' size. Such therapies alone are rarely effective; consequently, the treatment of choice is polypectomy (intranasal removal of the polyp with a wire snare), usually performed under local anesthesia. Continued recurrence may require surgical opening of the ethmoid and maxillary sinuses and evacuation of diseased tissue.

Caldwell-Luc surgery may be done to allow entry into the maxillary sinus for polyp removal.

Prevention

In many cases, polyps can't be prevented. But if you have asthma, hay fever or chronic sinus infections, managing your symptoms may reduce the chances that polyps will develop or recur. That means taking medications as your doctor suggests and avoiding — as much as possible — indoor and outdoor allergens and pollutants.