Nasal Polyps

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Basics

  • Chronic inflammatory lesion of nasal mucosa
  • Arise from ethmoidal cells but can arise from maxillary sinus mucosa although less common

Description

  • Appearance of edematous pedunculated mass in the nasal cavity or within the paranasal sinus
  • Often causes symptoms of blockage, discharge, or loss of smell
  • Most commonly bilateral; if unilateral, malignancy should be on differential.

Epidemiology

Prevalence
  • ~4% in general population
  • Much rarer in children: ~0.1% and associated with cystic fibrosis
  • Increases with age
  • Female > male (2:1)
  • Asthma is present in 65% of patients.

Etiology and Pathophysiology

Genetics
  • No clearly delineated pathway; research has demonstrated separate TH1- and TH2-driven pathways (1)[B].
  • Development of condition remains unclear; multiple inflammatory and infectious pathways resulting from chronic rhinosinusitis is most common.

General Prevention

Use of intranasal corticosteroids after polyp removal surgery has shown effectiveness against recurrence.

Commonly Associated Conditions

  • Asthma
  • Bronchiectasis
  • Aspirin hypersensitivity
  • Allergic rhinitis
  • Chronic sinusitis
  • Allergic fungal sinusitis
  • Cystic fibrosis
  • Primary ciliary dyskinesia (Kartagener syndrome)
  • Laryngopharyngeal reflux

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Basics

  • Chronic inflammatory lesion of nasal mucosa
  • Arise from ethmoidal cells but can arise from maxillary sinus mucosa although less common

Description

  • Appearance of edematous pedunculated mass in the nasal cavity or within the paranasal sinus
  • Often causes symptoms of blockage, discharge, or loss of smell
  • Most commonly bilateral; if unilateral, malignancy should be on differential.

Epidemiology

Prevalence
  • ~4% in general population
  • Much rarer in children: ~0.1% and associated with cystic fibrosis
  • Increases with age
  • Female > male (2:1)
  • Asthma is present in 65% of patients.

Etiology and Pathophysiology

Genetics
  • No clearly delineated pathway; research has demonstrated separate TH1- and TH2-driven pathways (1)[B].
  • Development of condition remains unclear; multiple inflammatory and infectious pathways resulting from chronic rhinosinusitis is most common.

General Prevention

Use of intranasal corticosteroids after polyp removal surgery has shown effectiveness against recurrence.

Commonly Associated Conditions

  • Asthma
  • Bronchiectasis
  • Aspirin hypersensitivity
  • Allergic rhinitis
  • Chronic sinusitis
  • Allergic fungal sinusitis
  • Cystic fibrosis
  • Primary ciliary dyskinesia (Kartagener syndrome)
  • Laryngopharyngeal reflux

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