Nasal polyps

Last reviewed: 28 Apr 2022
Last updated: 17 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • nasal obstruction
  • nasal discharge
  • facial pain/pressure
  • direct visualisation
More key diagnostic factors

Other diagnostic factors

  • reduced sense of smell/anosmia
  • cough
Other diagnostic factors

Risk factors

  • asthma
  • eosinophilic granulomatous polyangiitis (EGPA, also known as Churg-Strauss syndrome)
  • allergic fungal rhinosinusitis (AFRS)
  • aspirin sensitivity
  • genetic predisposition
More risk factors

Diagnostic investigations

1st investigations to order

  • anterior rhinoscopy
  • nasal endoscopy
More 1st investigations to order

Investigations to consider

  • CT sinuses
  • biopsy
  • nasal smear and culture
  • FBC with differential
  • antineutrophil cytoplasm antibodies (ANCA)
  • erythrocyte sedimentation rate (ESR)
  • skin-prick tests/serum allergen-specific IgE tests
  • nasal airway assessment
  • aspirin challenge
  • olfaction studies
  • quality-of-life measures
More investigations to consider

Treatment algorithm

ACUTE

mild to moderate polyposis (VAS 0-7)

severe polyposis (VAS >7)

Contributors

Authors

Hesham A. Saleh, MBBCh, FRCS, FRCS (ORL-HNS)
Hesham A. Saleh

Consultant Rhinologist

Charing Cross Hospital

Professor of Practice in Rhinology

Imperial College

London

UK

Disclosures

HAS declares that he has no competing interests.

Guy Scadding, FRCP, PhD

Consultant Allergist

Royal Brompton and Harefield NHS Trust

London

UK

Disclosures

GS declares that he has no competing interests.

Acknowledgements

Dr Hesham A. Saleh and Dr Guy Scadding would like to gratefully acknowledge Dr Richard J. D. Hewitt and Dr Romana Kuchai, previous contributors to this topic.

Disclosures

RJDH and RK declare that they have no competing interests.

Peer reviewers

Sietze Reitsma, MD, PhD

Rhinologist

Amsterdam University Medical Centers

Amsterdam

Netherlands

Disclosures

SR declares that he has no competing interests.

  • Nasal polyps images
  • Differentials

    • Neoplasm
    • Congenital lesions (e.g., encephalocoele, concha bullosa)
    • Foreign body
    More Differentials
  • Guidelines

    • European position paper on rhinosinusitis and nasal polyps 2020
    • Canadian clinical practice guidelines for acute and chronic rhinosinusitis
    More Guidelines
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