Nasal Polyps
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Nasal polyps are benign, inflammatory swellings of the nasal mucosa, typically arising from the paranasal sinuses, leading to nasal obstruction and other associated symptoms.
Aetiology
- Chronic inflammation: associated with conditions such as asthma, allergic rhinitis, and chronic rhinosinusitis.
- Aspirin exacerbated respiratory disease (AERD): characterised by nasal polyps, asthma, and aspirin sensitivity.
- Genetic predisposition: familial tendencies in some cases.
- Cystic fibrosis: nasal polyps are common in children with cystic fibrosis.
Pathophysiology
- Chronic mucosal inflammation leads to oedema, proliferation of fibroblasts, and increased glandular secretions.
- Polyp formation results in obstruction of nasal passages and impaired mucociliary clearance.
- Histologically, polyps show eosinophilic infiltration and oedematous stroma.
Risk Factors
- Asthma.
- Allergic rhinitis.
- Chronic rhinosinusitis.
- Aspirin sensitivity.
- Cystic fibrosis.
Signs and Symptoms
- Nasal obstruction: bilateral blockage affecting airflow.
- Rhinorrhoea: persistent nasal discharge.
- Hyposmia or anosmia: reduced or absent sense of smell.
- Postnasal drip: sensation of mucus dripping down the throat.
- Facial pressure or headache: due to sinus involvement.
- Mouth breathing: common in severe cases.
Investigations
- Anterior rhinoscopy: visualises polyps in the nasal cavity.
- Nasal endoscopy: provides detailed assessment of polyp location and severity.
- CT scan of sinuses: evaluates extent of disease and sinus involvement.
- Allergy testing: identifies potential allergic triggers.
- Genetic testing: for cystic fibrosis in paediatric cases with recurrent polyps.
Management
1. Medical Treatment:
- Intranasal corticosteroids: first line treatment (e.g., mometasone, fluticasone).
- Oral corticosteroids: for severe cases or acute exacerbations.
- Antihistamines: if allergic rhinitis is present.
- Leukotriene receptor antagonists: in aspirin-exacerbated respiratory disease.
2. Surgical Management:
- Endoscopic sinus surgery: indicated for large or refractory polyps.
- Polypectomy: removes obstructive polyps but has a high recurrence rate.
3. Long-Term Management:
- Regular use of intranasal corticosteroids to prevent recurrence.
- Saline nasal irrigation to improve mucosal clearance.
4. Referral:
- ENT specialist: for persistent or recurrent nasal polyps.
- Respiratory specialist: if associated with severe asthma or AERD.
- Genetics: if cystic fibrosis is suspected in children.