Polyp tissue comprises a mixture of loose connective tissue, edema, inflammatory cells (mostly eosinophils), glandular cells, and capillaries. Polyps are usually covered with respiratory pseudostratified epithelium with ciliated cells and goblet cells.
The etiology is unknown.
Symptoms are due to the size and location of the polyps and associated mucosal inflammation; they include nasal congestion and blockage, rhinorrhea, posterior nasal drip, and decreased sense of smell.
It is important to distinguish nasal polyps from neoplastic lesions, particularly if symptoms are unilateral.
The mainstay of treatment is topical corticosteroids; nasal saline irrigation can be beneficial in addition; endoscopic sinus surgery is indicated in patients who do not respond to medical therapy.
Chronic rhinosinusitis with nasal polyps is strongly associated with asthma.
Nasal polyps (NP) are benign swellings of the mucosal lining of the paranasal sinuses. They are invariably associated with chronic rhinosinusitis with the presentation correctly labelled as chronic rhinosinusitis with nasal polyps (CRSwNP). This distinguishes the presentation from chronic rhinosinusitis without nasal polyps (CRSsNP), which is covered in a separate topic. 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. Clinical features of CRSwNP include nasal congestion and blockage, rhinorrhea, posterior nasal drip, and decreased sense of smell.
History and exam
Key diagnostic factors
- nasal obstruction
- nasal discharge
- facial pain/pressure
- direct visualization
Other diagnostic factors
- reduced sense of smell/anosmia
- eosinophilic granulomatous polyangiitis (EGPA, also known as Churg-Strauss syndrome)
- allergic fungal rhinosinusitis (AFRS)
- aspirin sensitivity
- genetic predisposition
1st investigations to order
- anterior rhinoscopy
- nasal endoscopy
Investigations to consider
- CT sinuses
- nasal smear and culture
- CBC 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
mild to moderate polyposis (VAS 0-7)
severe polyposis (VAS >7)
- Congenital lesions (e.g., encephalocele, concha bullosa)
- Foreign body
- European position paper on rhinosinusitis and nasal polyps 2020
- Canadian clinical practice guidelines for acute and chronic rhinosinusitis
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