Nasal Polyps

Question 1

What are nasal polyps?

Answer 1

Nasal polyps are growths of the nasal mucosa that can occur in the nasal cavity or sinuses. They are often associated with inflammation, particularly with chronic rhinitis. They grow slowly and gradually obstruct the nasal passage.

Question 2

Are bilateral or unilateral nasal polyps a red flag presentation?

Answer 2

Polyps are usually bilateral. Unilateral nasal polyps are a red flag and should raise suspicions of tumours.

Question 3

What conditions are nasal polyps associated with?

Answer 3

Nasal polyps are associated with several conditions:

• Chronic rhinitis or sinusitis
• Asthma
• Samter’s triad
  
  • Nasal polyps, asthma and aspirin intolerance/allergy
• Cystic fibrosis
• Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

Question 4

What 3 conditions are involves in Samter’s triad?

Answer 4

Nasal polyps, asthma and aspirin intolerance/allergy.

Question 5

What are the clinical features of nasal polyps?

Answer 5

Nasal polyps may be found on examination in patients presenting with:

• Chronic rhinosinusitis
• Difficulty breathing through the nose
• Snoring
• Nasal discharge
• Loss of sense of smell (anosmia)

Question 6

How do nasal polyps appear on examination?

Answer 6

You can examine the nose with a nasal speculum, which holds the nostrils open. Alternatively, you can use an otoscope with a large speculum attached. A specialist can perform nasal endoscopy to visualise the nasal cavity in detail to assess any polyps.

Nasal polyps appear as round pale grey/yellow growths on the mucosal wall.

Question 7

Briefly describe the management of unilateral nasal polyps

Answer 7

Unilateral polyps should be referred for specialist assessment to exclude malignancy.

Question 8

Briefly describe the medical management of bilateral nasal polyps

Answer 8

Medical management involves intranasal topical steroid drops or spray.

Question 9

Briefly describe the surgical management of bilateral nasal polyps

Answer 9

Surgical management is used where medical treatment fails. This involves removing the polyps:

• Intranasal polypectomy is used where the polyps are visible close to the nostrils
• Endoscopic nasal polypectomy is used where the polyps are further in the nose or the sinuses