Nasal Polyps

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Nasal polyps are non-cancerous, painless, and soft growths that develop on the lining of the nasal passages or sinuses due to chronic inflammation.

Aetiology

The exact cause of nasal polyps is not fully understood, but they are associated with conditions that cause chronic inflammation in the nasal passages, such as:

• Chronic rhinosinusitis
• Asthma
• Allergic rhinitis
• Aspirin sensitivity
• Cystic fibrosis
• Allergic fungal sinusitis

Pathophysiology

Chronic inflammation of the nasal mucosa leads to the development of oedematous, hyperplastic lesions in the nasal cavity and sinuses. These lesions can become polyps, which are characterised by a thickened, gelatinous consistency due to extracellular fluid accumulation.

Risk Factors

• Chronic sinusitis
• Asthma
• Allergies
• Family history of nasal polyps
• Cystic fibrosis
• Age (more common in adults)
• Aspirin-exacerbated respiratory disease (AERD)

Signs and Symptoms

Common signs and symptoms of nasal polyps include:

• Nasal congestion and obstruction
• Rhinorrhoea (runny nose)
• Postnasal drip
• Reduced or lost sense of smell (anosmia)
• Loss of taste
• Facial pain or pressure
• Snoring
• Frequent sinus infections

Investigations

• Clinical history and physical examination
• Nasal endoscopy to visually inspect the nasal passages and sinuses
• Imaging studies (CT scan) to assess the extent of the polyps and sinus involvement
• Allergy testing if allergic rhinitis is suspected

Management

Primary Care Management

• Intranasal corticosteroids: First-line treatment to reduce inflammation and polyp size (e.g., fluticasone, mometasone)
• Saline nasal irrigation: To help clear nasal passages and reduce congestion
• Oral corticosteroids: Short courses may be prescribed for severe symptoms or large polyps (e.g., prednisolone)
• Referral to an ENT specialist if symptoms persist or recur

Specialist Management

• Endoscopic sinus surgery: To remove polyps and improve sinus drainage if medical management is ineffective
• Biologics: Monoclonal antibodies (e.g., dupilumab) for severe cases not responding to other treatments
• Allergy management: Immunotherapy for underlying allergic conditions
• Regular follow-up and monitoring for recurrence

References

1. NICE. (2024). Chronic Rhinosinusitis and Nasal Polyps: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Nasal Polyps. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Nasal Polyps: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). (2021). Clinical Practice Guideline: Chronic Rhinosinusitis with Nasal Polyps. Retrieved from AAO-HNS

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