Nasal Polyps

Question 1

What are nasal polyps?

Answer 1

Benign swellings of the mucosal lining of the paranasal sinuses.

Question 2

What risk factors for nasal polyps?

Answer 2

• Asthma
• Eosinophilic granulomatous polyangiitis (EGPA, also known as Churg-Strauss syndrome)
• Allergic fungal rhinosinusitis (AFRS)
• Aspirin sensitivity

Question 3

What are the signs of nasal polyps?

Answer 3

• Direct visualisation

Question 4

What are the symptoms of nasal polyps?

Answer 4

• Nasal obstruction
• Nasal discharge
• Facial pain and pressure
• Reduces sense of taste and smell

Question 5

Briefly describe the composition of nasal polyps

Answer 5

• Mixture of loose connective tissue, oedema, inflammatory cells (mostly eosinophils), glandular cells, and capillaries.
• Polyps are covered with varying types of epithelium, mostly respiratory pseudostratified epithelium with ciliated cells and goblet cells.

Question 6

Which condition is nasal polyps commonly seen in?

Answer 6

Chronic rhinosinusitis

Question 7

What investigations should be ordered for nasal polyps?

Answer 7

• Anterior rhinoscopy
• Nasal endoscopy

Question 8

Why investigate using anterior rhinoscopy? And what may this show?

Answer 8

• Visualisation is essential for a diagnosis of nasal polyps to be made.
• Polyps visualised.

Question 9

Why investigate using nasal endoscopy? And what may this show?

Answer 9

• May be required if polyps not seen on anterior rhinoscopy. Visualisation is essential for a diagnosis of NP to be made.
• Polyps visualised.

Question 10

When is CT imgaging and biopsy indicated for nasal polyps? And why?

Answer 10

Unilateral polyps are suspicious of a neoplasm and are investigated with CT imaging and biopsy.

Question 11

Briefly describe the treatment of nasal polyps

Answer 11

• Intranasal corticosteroid
• Nasal saline irrigation
• Doxycycline
• Surgical polypectomy

Question 12

When is surgical polypectomy indicated?

Answer 12

If there is no or minimal improvement in symptoms after the initial 3 months of medical treatment, many clinicians suggest surgery to remove the polyps.

Question 13

What complications are associated with nasal polyps?

Answer 13

• Periorbital and orbital cellulitis
• Cavernous sinus thrombosis
• Osteomyelitis

Question 14

What differentials should be considered for nasal polyps?

Answer 14

• Neoplasm
• Congenital lesions (e.g. encephalocele or concha bullosa)
• Foreign body

Question 15

How does nasal polyps and neoplasm differ?

Answer 15

• Signs and symptoms: features that may suggest neoplasm include unilateral symptoms, epistaxis/bleeding, crusting, cacosmia (perception of foul odour), periorbital oedema, displaced globe, double or reduced vision, ophthalmoplegia, severe frontal headaches, frontal swelling, signs of meningitis or focal neurology, and systemic symptoms such as weight loss.
• Investigations: CT head defines extent and characteristics of the lesion(s). MRI can be performed in conjunction with CT for further evaluation. Biopsy confirms histology.

Investigations:

Question 16

How does nasal polyps and congenital lesions (e.g. encephalocele and concha bullosa) differ?

Answer 16

• Signs and symptoms: concha bullosa is often asymptomatic, but may cause sinus obstruction. Encephalocoele symptoms are dependent on size and location.
• Investigations: CT and MRI head defines extent and characteristics of the lesion(s).

Question 17

How does nasal polyps and foreign body differ?

Answer 17

• Signs and symptoms: usually sudden onset of unilateral symptoms. Epistaxis may feature.
• Investigations: nasendoscopy may allow identification and possible retrieval of foreign body.