Nasal polyps

Nasal polyps are invariably associated with chronic rhinosinusitis, and strongly associated with asthma.

Symptoms are due to the size and location of the polyps and associated mucosal inflammation; they include nasal congestion and blockage, facial pressure, rhinorrhea, posterior nasal drip, and decreased sense of smell.

It is important to distinguish nasal polyps from neoplastic lesions, particularly if symptoms are unilateral.

Treatment options for chronic rhinosinusitis with nasal polyps (CRSwNP) include topical therapies such as intranasal corticosteroids and nasal irrigations, systemic drugs including biologics, and surgery.

Aspirin therapy after desensitization can be considered in patients with nasal polyps with a convincing history of a respiratory reaction to aspirin/nonsteroidal anti-inflammatory drugs (NSAIDs).

Chronic sinusitis, also known as chronic rhinosinusitis, is inflammation of the paranasal sinuses lasting more than 12 weeks.[1]Payne SC, McKenna M, Buckley J, et al. Clinical practice guideline: adult sinusitis update. Otolaryngol Head Neck Surg. 2025 Aug;173 Suppl 1:S1-56. https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1002/ohn.1344 http://www.ncbi.nlm.nih.gov/pubmed/40742114?tool=bestpractice.com It can be classified into two groups, with and without polyps, which have slightly different treatment regimens. This topic discusses chronic rhinosinusitis in the presence of polyps.

Nasal polyps are benign swellings of the mucosal lining of the paranasal sinuses.

Polyp tissue comprises a mixture of loose connective tissue, edema, inflammatory cells (mostly eosinophils), glandular cells, and capillaries. Polyps are covered with varying types of epithelium, mostly respiratory pseudostratified epithelium with ciliated cells and goblet cells.[2]​Cardesa A, Alos L, Nadal A, et al. Nasal cavity and paranasal sinuses. In: Cardesa A, Slootweg P, Gale N, et al. eds. Pathology of the head and neck. Berlin, Heidelberg: Springer; 2017. https://link.springer.com/chapter/10.1007/978-3-662-49672-5_2

Clinical features of CRSwNP include nasal congestion and blockage, rhinorrhea, posterior nasal drip, and decreased sense of smell.[3]Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020 Feb 20;58(suppl s29):1-464. http://www.ncbi.nlm.nih.gov/pubmed/32077450?tool=bestpractice.com ​​[Figure caption and citation for the preceding image starts]: Grade 3 nasal polypsFrom the collection of Dr Richard Hewitt [Citation ends].

This topic does not cover chronic rhinosinusitis in the absence of nasal polyps. See Chronic rhinosinusitis without nasal polyps.