Polyps

• Nasal polyps:

  • Painless growths of nasal mucosa that can occur in the nasal cavity or sinuses
  • Often associated with inflammation, particularly with chronic rhinitis
  • Chronic inflammation causes oedema to lining of cavity - gravity causes swelling to hang down (dependent oedema) forming the polyp
  • Usually affect both nostrils and can enlarge to block the passage
  • Unilateral = red flag (tumours)
• Demographics:

  • Most cases in over 40s
  • Twice as common in men
  • Rare in children - check for cystic fibrosis
• Associated conditions:

  • Chronic rhinosinusitis
  • Asthma: Samter's triad = nasal polyps, asthma and aspirin intolerance/allergy
  • Eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome)
  • Cystic fibrosis
• Symptoms:

  • Blocked feeling in nose - can make voice change
  • Mouth breathing
  • Snoring/obstructive sleep apnoea
  • Rhinorrhoea - watering from nose
  • Post-nasal drip
  • Anosmia
  • Sinusitis (if block opening from sinus into nasal cavity)
• Examination findings:

  • Appear as round pale grey/yellow growths on the mucosal wall
• Visualising polyps:

  • Can be seen with nasal speculum or when using otoscope with large speculum attached
  • ENT can perform nasal endoscopy to visualise cavity in detail
  • Occasionally CT or MRI required
• Unilateral polyp = refer for specialist assessment to exclude malignancy
• Medical management:

  • Intranasal topical steroid drops or spray (high dose then reduce to lower maintenance dose)
  • Occasionally (polyp confirmed by ENT and severe symptoms) short course of oral steroids can be considered
  • If poor response to medical management (3 months) - refer for surgery
• Surgical management:

  • Intranasal polypectomy - when polyps visible/close to nostrils
  • Endoscopic nasal polypectomy - when polyp further in the nose or sinuses
• When to refer to ENT:

  • if need to confirm diagnosis
  • Red flags
  • Significant obstruction