Contents

Search

nasal polyp

Etiology: - asthma - aspirin sensitivity - allergic fungal sinusitis - cystic fibrosis - Churg-Strauss syndrome Epidemiology: - more common in adults Clinical manifestations: - may be asymptomatic - stuffy nose blocking nasal passages - described as pale mucoid masses filling nasal cavity upon rhinoscopy [10] - rhinitis - postnasal drip - anosmia - dysgeusia (loss of sense of taste) - facial pain or headache - snoring Laboratory: - nasal swears - microscopy - bacterial culture - fungal culture Special laboratory: - nasal & sinus endoscopy with biopsy - pseudostratified epithelium is usually found - eosinophils may be present Radiology: - CT of paranasal sinuses without contrast [8] - coronal CT with 3-4 mm cuts - appropriate soft tissue & bone window - rule out malignancy, identify additional nasal polyp - identify presence & extent of chronic rhinosinusitis Complications: - frequent or chronic sinusitis - obstructive sleep apnea - altered facial structure leading to diplopia or wide-set eyes (cystic fibrosis) Management: - nasal glucocorticoids (initial treatment of choice) [10] - oral glucocorticoids are the most effective [8] - add-on therapy with dupilumab may be an effective for patients with nasal polyposis insufficiently responsive to nasal glucocorticoids [4,5] - omalizumab may be of benefit [6] - surgery: - polypectomy - endoscopic sinus surgery - good short-term relief, but minimally effective at 1 year [7]

Specific

choanal polyp nasal polyps with asthma; aspirin-exacerbated respiratory disease; Samter syndrome

General

polyp

References

  1. Nasal polyps: Mayo Clinic http://www.mayoclinic.com/health/nasal-polyps/DS00498
  2. Archer SM eMedicine: Nasal polyps, Nonsurgical treatment http://emedicine.medscape.com/article/861353-overview
  3. McClay JE and Isaacson GC eMedicine: Nasal Polyps http://emedicine.medscape.com/article/994274-overview
  4. Bachert C, Mannent L, Naclerio RM et al Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. JAMA. 2016 Feb 2;315(5):469-479. PMID: 26836729
  5. Bachert C, Han JK, Desrosiers M et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): Results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet 2019 Sep 19; S0140-6736(19)31881-1; PMID: 31543428 - Stevens WW. A new treatment for chronic rhinosinusitis with nasal polyps. Lancet 2019 Sep 19; S0140-6736(19)32133-6; PMID: 31543427
  6. Gevaert P et al. Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials. J Allergy Clin Immunol 2020 Sep; 146:595 PMID: 32524991 Free article https://www.jacionline.org/article/S0091-6749(20)30752-1/fulltext
  7. Lourijsen ES et al. Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: A multicentre, randomised, controlled trial. Lancet Respir Med 2022 Apr; 10:337. PMID: 35012708 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00457-4/fulltext
  8. Archer SM, Meyers AD Nonsurgical Treatment of Nasal Polyps. Medscape. April 1, 2021 https://emedicine.medscape.com/article/861353
  9. NEJM Knowledge+ Allergy/Immunology
  10. NEJM Knowledge+ Otolaryngology