When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Nasal polyps

Last reviewed: 21 Oct 2024
Last updated: 26 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • nasal obstruction
  • nasal discharge
  • polyps visible on examination or imaging
Full details

Other diagnostic factors

  • facial pain/pressure
  • reduced sense of smell/anosmia
  • cough
Full details

Risk factors

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

Diagnostic tests

1st tests to order

  • anterior rhinoscopy
  • nasal endoscopy
Full details

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
Full details

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 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.

  • Nasal polyps images
  • Differentials

    • Nasopharyngeal cancer
    • Congenital lesions (e.g., encephalocele, concha bullosa)
    • Foreign body
    More Differentials
  • Guidelines

    • 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 Guidelines
  • Videos

    How to examine the nasal cavity

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer