Overview

Nasal polyps are benign swellings of the nasal mucosa and paranasal sinuses. They are associated with chronic rhinosinusitis. It is essential to distinguish nasal polyps from more malicious pathology, such as nasal tumours.

Samter’s triad describes the coexistence of nasal polyps, asthma, and aspirin sensitivity.

Epidemiology

  • Males are affected more than females
  • Affects around 4% of the UK population

Risk Factors and Associations

Presentation

The main features are:

  • Nasal obstruction
  • Nasal discharge, including post-nasal drip
    • This may cause a chronic cough
  • Facial pain/pressure
  • Anosmia/reduced sense of smell

Differential Diagnoses

Neoplastic disease

  • Unilateral symptoms are a red flag for neoplasm
  • Associated periorbital oedema/ophthalmoplegia may be present
  • Crusting, bleeding, smelling foul odours may be present

Investigations

All patients

  • All patients with nasal polyps should be referred to ENT for full assessment:
  • Rhinoscopy:
    • Visualises polyps
  • Nasal endoscopy:
    • Assesses polyps in more detail

Referral

  • All patients with nasal polyps should be referred to ENT for a full assessment
  • Unilateral polyps/bleeding should urgently be referred to ENT:
    • These may suggest malignancy
  • Children with polyps should be referred for cystic fibrosis testing

Management

All patients

  • If not already done, refer to ENT
  • 1st-line: topical corticosteroids
  • Consider functional endoscopic sinus surgery

Monitoring

  • Patients are usually followed up every 6-12 months to assess response to treatment and adherence. They are followed up more closely if symptoms worsen.

Patient Advice

  • Patients should be educated on the importance of adherence to treatment to control symptoms.

Complications

  • Reduced quality of life
  • Sleep disruption
  • Acute bacterial sinusitis

Prognosis

  • Recurrence is common including after surgery

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