eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Nasal Polyps, Nonsurgical Treatment

Author: Sanford M Archer, MD, Associate Professor, Department of Surgery and Pediatrics, Division of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center
Contributor Information and Disclosures

Updated: Jun 15, 2009

Introduction

Background

Nasal polyposis is an inflammatory condition of unknown etiology. Nasal polyps are the most common tumors of the nasal cavity. Approximately 30% of patients with nasal polyps test positive for environmental allergies. The prevalence of nasal polyps is increased in children with cystic fibrosis and persons with known aspirin hypersensitivity. Nasal polyposis can impair a person's quality of life more than perennial allergic rhinitis. Olfaction and nasal obstruction are the most important considerations in terms of symptoms.

Pathophysiology

Nasal polyposis results from chronic inflammation of the nasal and sinus mucous membranes. Chronic inflammation causes a reactive hyperplasia of the intranasal mucosal membrane, which results in the formation of polyps. The precise mechanism of polyp formation is incompletely understood.

In 1990, Tos reported 10 pathogenic theories of nasal polyp formation:1

  • Adenoma and fibroma theories
  • Necrosing ethmoiditis theory
  • Glandular cyst theory
  • Mucosal exudate theory
  • Cystic dilatation of the excretory duct and vessel obstruction theory
  • Blockade theory
  • Periphlebitis and perilymphangitis theory
  • Glandular hyperplasia theory
  • Gland new formation theory
  • Ion transport theory

Multiple chemical mediators have been identified in nasal polyps but their significance has not been completely elucidated.  Some of these mediators may be released by the polyps themselves and others by the eosinophils found in certain subsets of polyps. Cysteinyl leukotriene receptors and interleukin-5 (IL-5) appear to be the most well studied.

Frequency

United States

Nasal polyps are present in 5% of nonallergic people and only 1.5% of people with allergic rhinitis. No racial or sexual predilection is reported. The prevalence is increased in patients with cystic fibrosis and aspirin-hypersensitivity triad.

Mortality/Morbidity

Morbidity from polyps is directly related to their location and size.

  • Obstruction of the sinus ostia frequently occurs and may lead to acute or chronic sinus conditions. With increased growth, polyps can cause bony destruction because they can exert pressure on bone. Polyps may cause destruction of the nasal bones or other facial bones.
  • Nasal obstruction due to polyposis can also lead to hyposmia or even anosmia.
  • Nasal polyps are not known to be premalignant. However, they may be confused with papillomas, including inverting papillomas, which are known to be precursors of malignant lesions. In addition, polyps can sometimes arise from inflammation caused by malignant or premalignant nasal lesions. These polyps can obstruct visualization of the more concerning lesions and sometimes cause delay in diagnosis.

Clinical

History

Patients with massive nasal polyposis typically present with increasing nasal congestion, hyposmia to anosmia, changes in sense of taste, and persistent postnasal drainage. Headaches and facial pain and discomfort are not uncommon and are found in the periorbital and maxillary regions. On occasion, a patient with completely obstructing nasal polyposis presents with symptoms of obstructive sleep apnea.

Patients with solitary polyps frequently present with only symptoms of nasal obstruction, which may change with a shift in position. For example, while lying supine, the polyp may swing posteriorly, opening up the nasal cavity. In an upright position, the polyp has a more obstructive effect.

Whether 1 or more polyps are present, patients may have symptoms of acute, recurrent, or chronic rhinosinusitis if the polyps obstruct the sinus ostia.

Physical

Intranasal examination reveals a fleshy translucent mass or masses in the nasal cavity, usually originating in the superior nasal vault. Polyps can be observed originating in the ethmoid region, from the maxillary sinus ostium (antral choanal polyps), the turbinates, or the septum. Obstructing polyps may make thorough intranasal examination difficult.

Mucopurulent discharge occasionally emanate from the ethmoid region or the superior nasal vault, suggesting an underlying rhinosinusitis. Septal deformities may make the examination more difficult.

Causes

  • Allergy2
  • Chronic sinusitis
  • Chronic inflammation of indeterminate etiology

More on Nasal Polyps, Nonsurgical Treatment

Overview: Nasal Polyps, Nonsurgical Treatment
Differential Diagnoses & Workup: Nasal Polyps, Nonsurgical Treatment
Treatment & Medication: Nasal Polyps, Nonsurgical Treatment
Follow-up: Nasal Polyps, Nonsurgical Treatment
Multimedia: Nasal Polyps, Nonsurgical Treatment
References
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References

  1. Tos M. The pathogenic theories on the formation of nasal polyps. Am J Rhinol. 1990;4:51-6.

  2. Bernstein JM, Gorfien J, Noble B. Role of allergy in nasal polyposis: a review. Otolaryngol Head Neck Surg. Dec 1995;113(6):724-32. [Medline].

  3. Becker SS, Rasamny JK, Han JK, Patrie J, Gross CW. Steroid injection for sinonasal polyps: the University of Virginia experience. Am J Rhinol. Jan-Feb 2007;21(1):64-9. [Medline].

  4. Bikhazi NB. Contemporary management of nasal polyps. Otolaryngol Clin North Am. Apr 2004;37(2):327-37, vi. [Medline].

  5. Burgel PR, Escudier E, Coste A, Dao-Pick T, Ueki IF, Takeyama K. Relation of epidermal growth factor receptor expression to goblet cell hyperplasia in nasal polyps. J Allergy Clin Immunol. Oct 2000;106(4):705-12. [Medline].

  6. Dagli M, Eryilmaz A, Besler T, Akmansu H, Acar A, Korkmaz H. Role of free radicals and antioxidants in nasal polyps. Laryngoscope. Jul 2004;114(7):1200-3. [Medline].

  7. Hamilos DL, Thawley SE, Kramper MA, Kamil A, Hamid QA. Effect of intranasal fluticasone on cellular infiltration, endothelial adhesion molecule expression, and proinflammatory cytokine mRNA in nasal polyp disease. J Allergy Clin Immunol. Jan 1999;103(1 Pt 1):79-87. [Medline].

  8. Nores JM, Avan P, Bonfils P. Medical management of nasal polyposis: a study in a series of 152 consecutive patients. Rhinology. Jun 2003;41(2):97-102. [Medline].

  9. Norlander T, Fukami M, Westrin KM, Stierna P, Carlsöö B. Formation of mucosal polyps in the nasal and maxillary sinus cavities by infection. Otolaryngol Head Neck Surg. Sep 1993;109(3 Pt 1):522-9. [Medline].

  10. Nucera E, Schiavino D, Milani A, Del Ninno M, Misuraca C, Buonomo A. Effects of lysine-acetylsalicylate (LAS) treatment in nasal polyposis: two controlled long term prospective follow up studies. Thorax. Oct 2000;55 Suppl 2:S75-8. [Medline].

  11. Parnes SM. Targeting cysteinyl leukotrienes in patients with rhinitis, sinusitis and paranasal polyps. Am J Respir Med. 2002;1(6):403-8. [Medline].

  12. Radenne F, Lamblin C, Vandezande LM, Tillie-Leblond I, Darras J, Tonnel AB. Quality of life in nasal polyposis. J Allergy Clin Immunol. Jul 1999;104(1):79-84. [Medline].

  13. Rinia AB, Kostamo K, Ebbens FA, van Drunen CM, Fokkens WJ. Nasal polyposis: a cellular-based approach to answering questions. Allergy. Apr 2007;62(4):348-58. [Medline].

  14. Saunders MW, Wheatley AH, George SJ, Lai T, Birchall MA. Do corticosteroids induce apoptosis in nasal polyp inflammatory cells? In vivo and in vitro studies. Laryngoscope. May 1999;109(5):785-90. [Medline].

  15. Singh H, Ballow M. Role of cytokines in nasal polyposis. J Investig Allergol Clin Immunol. 2003;13(1):6-11. [Medline].

  16. Steinke JW, Bradley D, Arango P, Crouse CD, Frierson H, Kountakis SE. Cysteinyl leukotriene expression in chronic hyperplastic sinusitis-nasal polyposis: importance to eosinophilia and asthma. J Allergy Clin Immunol. Feb 2003;111(2):342-9. [Medline].

  17. Tuncer U, Soylu L, Aydogan B, Karakus F, Akcali C. The effectiveness of steroid treatment in nasal polyposis. Auris Nasus Larynx. Aug 2003;30(3):263-8. [Medline].

  18. Winestock DP, Bartlett PC, Sondheimer FK. Benign nasal polyps causing bone destruction in the nasal cavity and paranasal sinuses. Laryngoscope. Apr 1978;88(4):675-9. [Medline].

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Further Reading

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Keywords

nasal polyps, nasal polyposis, nasal tumors, tumors of the nasal cavity, environmental allergies, olfaction, nasal obstruction, hyperplasia of the intranasal mucosal membrane

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Contributor Information and Disclosures

Author

Sanford M Archer, MD, Associate Professor, Department of Surgery and Pediatrics, Division of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center
Sanford M Archer, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Rhinologic Society, American Society for Head and Neck Surgery, and Kentucky Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Eric Moore, MD, Residency Director, Assistant Professor, Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Graduate School of Medicine
Eric Moore, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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