Nasal polyps or nasosinusal polyps are semitransparent lesions that can originate in any part of the nasosinusal mucosa and are often the final result of various pathological processes. They are frequently located in the drainage areas of the paranasal sinuses.
Causes of Nasal Polyps
Chronic inflammation of any type appears to be the trigger for polyp formation. When multiple, they are associated with chronic sinusitis, allergic rhinitis, cystic fibrosis, among others. When there is a single polyp, it may be of benign or malignant origin, and in children, it could be a congenital lesion.
Epidemiology of Nasal Polyps
This condition is more common in adults (4%) than in children (0.1%), although it is significantly more frequent in children with cystic fibrosis (6–48%). It affects women more than men and has a higher incidence after the age of 40.
Symptoms of Nasal Polyps
Symptoms mainly depend on the size of the polyp. A small polyp usually does not produce symptoms and may only be detected during a routine examination. When they are multiple or of significant size, they may cause:
- Nasal obstruction
- Rhinorrhea
- Hyposmia (reduced sense of smell) or anosmia (complete loss of smell)
- Snoring
- Headaches
Diagnosis of Nasal Polyposis
Physical examination:
This is carried out through anterior rhinoscopy and nasofibroscopy, which allow for evaluation of the anatomy of the nasal cavities as well as the extent and location of the nasal polyps.
Lesión polipoidea en meato medio derecho
Imaging tests: Nowadays, simple X-rays of the sinuses are not significantly useful once the diagnosis of polyps is made. If necessary, a CT scan of the paranasal sinuses is requested, as it is the most useful test—especially when surgical treatment is being planned. An MRI of the brain and paranasal sinuses may also be necessary when studying the origin and extension of a polypoid mass in the nasal cavities.
Other specialists: Since many patients with nasal polyposis also show allergic symptoms, testing for possible allergens is necessary for more targeted treatment. In these cases, patients should be evaluated and treated by an allergist. In children with multiple polyps, it is mandatory to rule out cystic fibrosis or other commonly associated conditions such as asthma, in which case pediatricians and pulmonologists should be consulted.
Treatment of Nasal Polyposis
The most effective pharmacological treatment for symptom control in nasal polyps is corticosteroids, either oral or nasal sprays. Antihistamines and immunotherapy may also be used depending on the case. In cases of superinfection, antibiotics are prescribed. Surgical treatment is generally indicated in symptomatic patients who do not respond to medical treatment, but assessment by a specialist is required to adjust the indication individually.
Prognosis of Nasal Polyposis
Nasal polyposis is not usually associated with significant mortality. The associated morbidity is mainly due to a decreased quality of life from the chronic symptoms, such as persistent nasal obstruction and anosmia. Multiple polyps are typically recurrent despite medical and surgical treatment, whereas single polyps have a lower tendency to recur.
Endoscopic sinus surgery has been shown to improve quality of life and olfaction in patients with chronic rhinosinusitis with polyps.
Finally, due to the recurrent nature of this condition, periodic follow-up is recommended for all patients, regardless of whether they received medical or surgical treatment.