Diagnosis

Nasal polyps

Etiology

Cause [6vk]

• Inflammatory/reactive polyps:

  • Chronic rhinosinusitis

  • Allergic rhinitis

  • Allergic fungal rhinosinusitis

  • Bacterial rhinosinusitis

  • Vasculitis (eosinophilic granulomatosis with polyangiitis)

  • Occupational dust

• Nasal papilloma associated with human papillomavirus

• Cystic fibrosis

Pathophysiology [6vk]

1. Allergy:

   • Environmental or seasonal allergic triggers

   • Eosinophilia and IgE inflammation --> elevated IL-5

   • Polyposis represents an end-stage manifestation of poorly controlled allergies

2. Infection:

   • Anatomical and functional changes

   • Impaired mucociliary clearance

   • Atrophy of the sinonasal mucosa --> diminished mucus secretion

   • Stasis of thick mucus --> impair the clearance of irritants and biological offenders

   • Risk of infection: viruses, bacteria, and fungi

   • Chronic inflammation --> localized increases in cell and tissue size (edema)

   • Increased susceptibility to polyp formation

3. Clinical presentation:

   • Asymptomatic

   • Nasal obstruction

   • Facial congestion

   • Anosmia

   • Ageusia

   • Rhinorrhea

Complications [6vk]

• Mucoceles --> orbital compression --> exophthalmos, diplopia

• Irreversible anosmia

• Obstructive sleep apnea

Epidemiology

Prevalence per 100.000 [hru][d3t][uva][2ip][csw][yy7]

Incidence per 100.000 [hru][d3t][uva][2ip][csw][yy7]

Approach

• Anterior rhinoscopy

• Nasal endoscopy

• CT caput

• Biopsy

Treatment

Local and systemic therapies targeting the underlying allergic etiology: [wes][6vk]

1. Continuing nasal saline irrigation

2. Corticosteroids (spray or oral)

3. Antibiotics

4. Antihistamines

5. Monoclonal antibodies

6. Surgery: endoscopic removal

   • Polypectomy

   • Balloon sinuplasty

   • Functional endoscopic sinus surgery

   • Biodegradable steroid-eluting stents

Differential diagnoses

Acute invasive fungal sinusitis, Acute sinusitis, Allergic rhinosinusitis, Chronic sinusitis, Encephalocele, Human papillomavirus, Lymphoma, Malignant melanoma, Obstructive sleep apnea, Rhinitis, Squamous cell carcinoma, Wegener's granulomatosis