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Nonsurgical Treatment of Nasal Polyps Workup

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

Laboratory Studies

See the list below:

  • Allergy testing in patients who have polyps and are not clinically allergic is controversial.
    • Many clinicians think that the expense is not justified.
    • On the contrary, a thorough allergy evaluation should be considered in patients with a history of environmental allergies or a strong family history of allergies.
  • Children who present with nasal polyposis should be tested for cystic fibrosis with either a sweat chloride test or with hematologic genetic testing.
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Imaging Studies

See the list below:

  • Coronal sinus CT is the imaging study of choice in the evaluation of patients with nasal polyposis.
    • Coronal CT of the paranasal sinuses is best for delineating the underlying pathology, the extent of disease, and possible bony destruction.
    • Nonenhanced CT with 2- to 3-mm sections helps to delineate the location and origin of the visible polyps, evaluate the underlying condition of all of the sinuses, and assess the anatomy of the paranasal sinuses in the event of surgical intervention.
  • MRI is not an appropriate imaging modality for nasal polyposis unless intracranial extension is suspected. Bony details of the paranasal sinus anatomy are poorly visualized on MRI.
  • Radiography with Waters views may show opacification of the sinuses.
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Procedures

Nasal endoscopy in an office setting can sometimes be helpful in the diagnosis and evaluation of nasal polyps. This technique helps illuminate and improves visualization of the dark recesses of the nasal cavity. Endoscopy may allow the examiner to see beyond an obstructing nasal septal deviation, an enlarged turbinate, or an obstructing polyp.

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Histologic Findings

Biopsy is not always required for the diagnosis of nasal polyps. Nasal masses that do not have the classic appearance of bilateral nasal polyps or that do not respond to conservative treatment should be examined with careful biopsy for diagnosis. The histologic appearance of nasal polyps varies from edematous tissue with a few glands to an increase in glandular elements. Eosinophils may be present, indicating an allergic component.

Many factors play a role in the formation of nasal polyp. Epithelial damage has been implicated in the pathogenesis of polyps. Epithelial cells can undergo activation in response to allergens, pollutants, and infectious agents. The cells release various factors that play a role in the inflammatory response and subsequent repair. The epithelium of nasal polyps shows goblet cell hyperplasia and mucous hypersecretion that may play a role in nasal obstruction and rhinorrhea.

Mucin synthesis and goblet cell hyperplasia are thought to be under control of epidermal growth factors (EGF). Inhibitors may block mucous production and goblet cell hyperplasia. Free radicals are highly reactive molecules with an unpaired electron in the outer orbit and may also play a role in polyp formation. The body produces endogenous oxidants as a result of the leakage of electrons from electron transport chains, phagocytic cells and endogenous enzyme systems (MAO, P450, etc).

Exogenous factors include radiation, air pollutants, tobacco smoke, sun exposure, ozone, and others. A certain physiologic level of reactive oxygen species is necessary for proper regulation of cell functions. Exposure to oxidants can initiate free radical-mediated reactions and lead to oxidative stress. Free radicals can result in cellular damage or death and subsequent tissue damage.

Several inflammatory factors have been isolated and are proven to be expressed by nasal polyps. These factors include endothelial vascular cell adhesion molecule (VCAM)-1, nitric oxide synthase, granulocyte-macrophage colony–stimulating factor (GM-CSF), eosinophil survival enhancing activity (ESEA), cys-leukotrienes (Cys-LT) and many other cytokines.

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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
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  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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