Summary
Definition
History and exam
Key diagnostic factors
- nasal obstruction
- nasal discharge
- polyps visible on examination or imaging
Other diagnostic factors
- facial pain/pressure
- reduced sense of smell/anosmia
- cough
Risk factors
- asthma
- eosinophilic granulomatous polyangiitis (EGPA, also known as Churg-Strauss syndrome)
- allergic fungal rhinosinusitis (AFRS)
- aspirin sensitivity
- genetic predisposition
Diagnostic tests
1st tests to order
- anterior rhinoscopy
- nasal endoscopy
Tests to consider
- CT sinuses
- biopsy
- nasal smear and culture
- CBC with differential
- antineutrophil cytoplasm antibodies (ANCA)
- erythrocyte sedimentation rate (ESR)
- skin prick tests/serum allergen-specific IgE tests
- aspirin challenge
- olfaction studies
- quality-of-life measures
- nasal airway assessment
Treatment algorithm
mild to moderate polyposis (VAS 0-7)
severe polyposis (VAS >7)
Contributors
Authors
Hesham A. Saleh, MBBCh, FRCS, FRCS (ORL-HNS)
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 has received lecture fees from ALK-Abello, Meda, and Glenmark Pharmaceuticals and sponsorship from GSK to attend a conference.
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.
Differentials
- Nasopharyngeal cancer
- Congenital lesions (e.g., encephalocele, concha bullosa)
- Foreign body
More DifferentialsGuidelines
- The Joint Task Force on Practice Parameters GRADE guidelines for the medical management of chronic rhinosinusitis with nasal polyposis
- European position paper on rhinosinusitis and nasal polyps 2020
More GuidelinesVideos
How to examine the nasal cavity
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