Nasal Polyps

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Chapter 370 Nasal Polyps

Joseph Haddad, Jr.

Etiology

Nasal polyps are benign pedunculated tumors formed from edematous, usually chronically inflamed nasal mucosa. They commonly arise from the ethmoidal sinus and occur in the middle meatus. Occasionally, they appear within the maxillary antrum and can extend to the nasopharynx (antrochoanal polyp).

It is estimated that between 0.2% and 1% of the population will develop nasal polyps at some time; the incidence of nasal polyps increases with age. Antrochoanal polyps represent only 4-6% of all nasal polyps in the general population but account for approximately one third of polyps in the pediatric population. Large or multiple polyps can completely obstruct the nasal passage. The polyps originating from the ethmoidal sinus are usually smaller and multiple, as compared with the large and usually single antrochoanal polyp.

Cystic fibrosis is the most common childhood cause of nasal polyposis and should be suspected in any child <12 yr old with nasal polyps, even in the absence of typical respiratory and digestive symptoms; as many as 30% of children with cystic fibrosis acquire nasal polyps (Chapter 395). Nasal polyposis is also associated with chronic sinusitis and allergic rhinitis. In the uncommon Samter triad, nasal polyps are associated with aspirin sensitivity and asthma.

Clinical Manifestations

Obstruction of nasal passages is prominent, with associated hyponasal speech and mouth breathing. Profuse unilateral mucoid or mucopurulent rhinorrhea may also be present. An examination of the nasal passages shows glistening, gray, grapelike masses squeezed between the nasal turbinates and the septum.

Diagnosis and Differential Diagnosis

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