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Nonsurgical Treatment of Nasal Polyps

  • Author: Sanford M Archer, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Mar 17, 2016
 

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.

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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.

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Epidemiology

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.
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Contributor Information and Disclosures
Author

Sanford M Archer, MD Professor, Department of Surgery and Pediatrics, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center

Sanford M Archer, MD is a member of the following medical societies: American College of Surgeons, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Rhinologic Society, Kentucky Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Eric J Moore, MD, FACS Residency Director, Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Graduate School of Medicine

Eric J Moore, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate-Craniofacial Association

Disclosure: Nothing to disclose.

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. 1995 Dec. 113(6):724-32. [Medline].

  3. Van Zele T, Gevaert P, Holtappels G, Beule A, Wormald PJ, Mayr S, et al. Oral steroids and doxycycline: two different approaches to treat nasal polyps. J Allergy Clin Immunol. 2010 May. 125(5):1069-1076.e4. [Medline].

  4. Martinez-Devesa P, Patiar S. Oral steroids for nasal polyps. Cochrane Database Syst Rev. 2011 Jul 6. CD005232. [Medline].

  5. Kirtsreesakul V, Wongsritrang K, Ruttanaphol S. Clinical efficacy of a short course of systemic steroids in nasal polyposis. Rhinology. 2011 Dec. 49(5):525-32. [Medline].

  6. Rudmik L, Schlosser RJ, Smith TL, Soler ZM. Impact of topical nasal steroid therapy on symptoms of nasal polyposis: a meta-analysis. Laryngoscope. 2012 Jul. 122(7):1431-7. [Medline].

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

  8. Moss WJ, Kjos KB, Karnezis TT, et al. Intranasal steroid injections and blindness: Our personal experience and a review of the past 60 years. Laryngoscope. 2014 Nov 6. [Medline].

  9. Kato A. Immunopathology of chronic rhinosinusitis. Allergol Int. 2015 Apr. 64 (2):121-30. [Medline]. [Full Text].

  10. Bachert C, Mannent L, Naclerio RM, et al. Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. JAMA. 2016 Feb 2. 315 (5):469-79. [Medline].

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

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

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

 
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Nasal polyposis, right nasal passage.
Nasal polyposis, right nasal passage.
 
 
 
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