Nasal polyps are masses of inflamed nasal or sinus mucosa that may extend into the nasal cavity by virtue of their size or weight. Typically they present as chronic nasal obstruction, chronic sinus infections or sinus headaches. Sometimes they may be visible through the nostril and in extreme cases may even extend outside of the nostril.
The most common cause of nasal polyps is allergic rhinitis. In this scenario, the polyps are often associated with clear nasal discharge, nasal congestion, and clear postnasal drip. Other symptoms of allergies, such as sneezing, sore throat, or watery eyes, may also be present. As the polyps grow, they may block the openings to the sinus cavities, resulting in chronic sinusitis. At this point, the typical symptoms may be yellow-green nasal discharge and post-nasal drip with sinus headaches.
Other causes of nasal polyps include non-allergic rhinitis, vasomotor rhinitis, aspirin sensitivity, cystic fibrosis, and lymphoma. Non-allergic and vasomotor rhinitis will be present with the same clinical picture as allergic rhinitis, and it may take negative skin testing to determine the diagnosis. A large proportion of patients with sensitivity to aspirin will develop nasal sinus polyps as well as asthma. Cystic fibrosis should be ruled out in children with nasal polyps and/or chronic sinusitis. In very rare cases, nasal polyps may be hiding a nasal/sinus lymphoma.
The initial treatment of nasal polyps usually employs a steroid to attempt to shrink the polyps. Nasal steroid sprays or oral steroids may be used. Antihistamines and decongestants may also be prescribed. Should the polyps fail to shrink, a CT scan of the sinuses is obtained to determine the extent of the polyps. Endoscopic sinus surgery is then performed to remove the polyps, open the sinuses, and provide for an adequate nasal airway. Post-operative allergy testing and immunotherapy are paramount in preventing the recurrence of nasal polyps. Although polypectomy is a very successful procedure, nasal polyps will recur 40-50% of the time, if the cause of the polyps is not treated. With allergy treatment, the recurrence rate is less than 10%.
