Nasal Polyps

By Alex Pearce-Smith

True of False?

       More common in men?

Equal gender incidence in asthmatics?

More common in Afro-carribeans?

Sensitive to touch?

Common in children?

Usually bilateral?

20% recurr after surgery?

Nasal Polyps

Background

    Most commonly seen in middle meatus.

Eosinophil-rich oedematous wall characterised by Goblet cell hyperplasia.

Uncertain pathogenesis but linked to chronic infection and inflammation, allergy AN dysfunction and genetics. Maybe single or multiple.

Incidence/Prevalance

     Approx 2% incidence of polyps.

Rare in children and declines after 60.

Males 2-4:1 Females (except Asthma 1:1) Prevalance – 1% adults – 0.1% children.

No racial predilection

Associations

     Infective Sinusitis – Staph, Strep, Bacteroides, Pseudomonas A, C.F. – if 16 or under consider this. Polyps found in upto 48% of children with CF.

Asthma – upto 50% prevalance.

Kartageners, Churg-Strauss, Primary ciliary diskinesia.

Not associated with Allergic Rhinitis!

Presentation

      Nasal airway obstruction.

Watery Rhinorrhoea, Post-nasal drip.

Obstructive sleep symptoms/snoring.

Anosmia.

Chronic mouth breathing.

Samster’s Triad – polpys+asthma+aspirin sensitivity.

Examination

   Distinguish from inferior turbinate as grey, able to get between them and the side of the nose and insensitive.

May be seen coming down into the oropharynx.

Usually Bilateral

Sinister Signs/Symptoms

     Unilateral – consider cancer.

Bleeding/Crusting Eye symptoms Severe unilateral frontal headache.

Meningitis sx or focal neurology.

Management

     Referral – unilateral, children etc.

Review associated diseases.

Education as to recurring nature.

Medical first line.

Aim of treatment is to relieve obstruction, restore olfaction, improve drainage.

Medical

   Topical corticosteroids – Mometasone, Fluticasone (safe in children). NB side effects. As nasal spray –this may be used continuously to prevent recurrence but at least 3M trial recommended) .

Step 2 – Betnesol drops – 2 drops TDS each nostril for a month (NB equiv 0.5mg prednisolone and caution in children).

– http://www.derbyshirecountypct.nhs.uk/content/ files/Clinical%20Guidelines/Nasal%20Polyposis% 20Guideline%2005(12).pdf

Oral steroids – specialist advice.

Surgical

    Alongside medical management if unsuccessful.

Either polypectomy or ethmoidectomy.

Recurrence common – 60% have repeat procedure within 5 yrs.

Less effective in patients with concurrent asthma.

True or False?

       More common in men?

Equal gender incidence in asthmatics?

More common in Afro-carribeans?

Sensitive to touch?

Common in children?

Usually bilateral?

20% recurr after surgery?

Questions?