Nonsurgical Treatment of Nasal Polyps 

  • Author: Sanford M Archer, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 30, 2012
 

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 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.

Specialty Editor Board

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 Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American Head and Neck Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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: Revent Medical Honoraria Review panel membership; Synthes Nursing Education Honoraria Other

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, 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 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, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

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  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. 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. May 2010;125(5):1069-1076.e4. [Medline].

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

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  6. 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].

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

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. 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].

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

  15. 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].

  16. 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].

  17. 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].

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

  19. 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].

  20. 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].

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