Nasal polyp

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	Nasal polyps;
ICD-10	J33
ICD-9	471
MedlinePlus	001641
eMedicine	ent/334 ent/335
MeSH	C09.603.557

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Overview

Nasal polyps are polypoidal masses arising mainly from the mucous membranes of the nose and paranasal sinuses.

Diagnosis

They are overgrowths of the mucosa that frequently accompany allergic rhinitis. They are freely moveable and non-tender. Nasal polyps are usually classified into antrochoanal polyps and ethmoidal polyps. Antrochoanal polyps arise from the maxillary sinuses and are much less common, ethmoidal polyps arise from the ethmoidal sinuses. Antrochoanal polyps are usually single and unilateral whereas ethmoidal polyps are multiple and bilateral.

History and Symptoms

Symptoms of polyps include nasal block, sinusitis, anosmia or loss of smell, and secondary infection leading to headache. [2]

Physical Examination

Ear Nose and Throat

The pathogenesis of nasal polyps is unknown. Nasal polyps are most commonly thought to be caused by allergy and rarely by cystic fibrosis although a significant number are associated with non-allergic adult asthma or no respiratory or allergic trigger that can be demonstrated.

These polyps have no relationship with colonic or uterine polyps. Irregular unilateral polyps particularly associated with pain or bleeding will require urgent investigation as they may represent an intranasal tumour.

CT images demonstrate a right nasal polyp

Treatment

Nasal polyps are most often treated with steroids, topical or oral, but can also be treated with surgical methods.

Pre-post surgery, sinus rinses with a warm water (240ml / 8oz) mixed with a small amount (teaspoon) of salts (sodium chloride & sodium bicarbonate) can be very helpful to clear the sinuses. This method can be also used as a preventative measure to discourage the polyps from growing back and should be used in combination with a nasal steroid.

Mometasone furoate, commonly available as a nasal spray for treating common allergy symptoms, has been indicated in the United States by the FDA for the treatment of nasal polyps since December 2004.