Nasal Polyps

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Basics

  • Chronic benign inflammatory lesion of nasal mucosa
  • Arise from near the ethmoid sinus but can infrequently arise from maxillary sinus mucosa

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

Incidence

  • Typical age at diagnosis ranges from 40 to 60 years.
  • Increases with age to a peak in the sixth decade

Prevalence

  • ~4% in general population
  • Much rarer in children: ~0.1% and associated with cystic fibrosis
  • Asthma is present in up to 65% of patients.

Etiology and Pathophysiology

  • Separate T helper 1- and T helper 2-driven pathways
  • White patients who have chronic rhinosinusitis with nasal polyps: Majority have type 2 pattern of inflammation.
    • Characterized by eosinophilia and elevated levels of interleukin-4, interleukin-5, and interleukin-13 cytokines

Genetics
Patients with nasal polyps are more likely than controls to report having a first-degree relative with nasal polyps (1)[B].

Risk Factors

An increased prevalence of nasal polyps has been described among textile workers who have been exposed to occupational dust, particularly among those with longer-duration exposure (1)[B].

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 (pediatric patients)
  • Primary ciliary dyskinesia (Kartagener syndrome)
  • Laryngopharyngeal reflux
  • Sleep apnea

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Basics

  • Chronic benign inflammatory lesion of nasal mucosa
  • Arise from near the ethmoid sinus but can infrequently arise from maxillary sinus mucosa

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

Incidence

  • Typical age at diagnosis ranges from 40 to 60 years.
  • Increases with age to a peak in the sixth decade

Prevalence

  • ~4% in general population
  • Much rarer in children: ~0.1% and associated with cystic fibrosis
  • Asthma is present in up to 65% of patients.

Etiology and Pathophysiology

  • Separate T helper 1- and T helper 2-driven pathways
  • White patients who have chronic rhinosinusitis with nasal polyps: Majority have type 2 pattern of inflammation.
    • Characterized by eosinophilia and elevated levels of interleukin-4, interleukin-5, and interleukin-13 cytokines

Genetics
Patients with nasal polyps are more likely than controls to report having a first-degree relative with nasal polyps (1)[B].

Risk Factors

An increased prevalence of nasal polyps has been described among textile workers who have been exposed to occupational dust, particularly among those with longer-duration exposure (1)[B].

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 (pediatric patients)
  • Primary ciliary dyskinesia (Kartagener syndrome)
  • Laryngopharyngeal reflux
  • Sleep apnea

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