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

Nasal Polyps, Surgical Treatment: Workup

Author: Andrew Cheng, MD, Clinical Assistant Professor, Department of Otolaryngology-Head & Neck Surgery, New York Medical College
Contributor Information and Disclosures

Updated: Mar 6, 2008

Workup

Laboratory Studies

  • Relevant allergy or asthma studies (if indicated)
  • Nasal smears or cultures for fungus and bacteria (if indicated)

Imaging Studies

  • CT scan of sinuses without contrast: Specify coronal CT with 3-4 mm cuts and appropriate soft tissue and bone windows.
    • Evaluate the CT scan results with attention to anterior ethmoid artery, orbital and skull base anomalies, optic nerve and carotid in posterior ethmoidal (Onodi) cells, and sphenoid sinus.
    • Focus especially on previous surgical changes. Consider role and use of image-guidance system in revision or difficult cases.3

Other Tests

  • Olfactory testing (if indicated)
  • Medical workup for cystic fibrosis (if indicated)

Diagnostic Procedures

  • A nasal and sinus endoscopy with evaluation of anatomy, site of origin, past surgical changes, and evidence of other disease-causing polyps (tumor, infection, systemic diseases such as Sarcoidosis, Wegener granulomatosis) may be appropriate (see Nasal Polyps, Nonsurgical Treatment).

Histologic Findings

Pseudostratified epithelium is usually found. Pay special attention to unilateral polyps that may be neoplastic, and examine them for malignancy or possible malignant transformation of benign neoplasia(20% in inverting papilloma).

Staging

Staging is relevant in inverted papilloma with malignant transformation.

More on Nasal Polyps, Surgical Treatment

Overview: Nasal Polyps, Surgical Treatment
Workup: Nasal Polyps, Surgical Treatment
Treatment: Nasal Polyps, Surgical Treatment
Follow-up: Nasal Polyps, Surgical Treatment
References
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References

  1. Deal RT, Kountakis SE. Significance of nasal polyps in chronic rhinosinusitis: symptoms and surgical outcomes. Laryngoscope. Nov 2004;114(11):1932-5. [Medline].

  2. Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl. 2007;(20):1-136. [Medline].

  3. Kingdom TT, Orlandi RR. Image-guided surgery of the sinuses: current technology and applications. Otolaryngol Clin North Am. Apr 2004;37(2):381-400. [Medline].

  4. Bhattacharyya N. Progress in surgical management of chronic rhinosinusitis and nasal polyposis. Curr Allergy Asthma Rep. June 2007;3:216-20. [Medline].

  5. Garrel R, Gardiner Q, Khudjadze M, Demoly P, Vergnes C, Makeieff M. Endoscopic surgical treatment of sinonasal polyposis-medium term outcomes (mean follow-up of 5 years). Rhinology. Jun 2003;41(2):91-6. [Medline].

  6. Gosepath J, Mann WJ. Current concepts in therapy of chronic rhinosinusitis and nasal polyposis. ORL J Otorhinolaryngol Relat Spec. 2005;67(3):125-36. [Medline].

  7. Mostafa BE, Abdel Hay H, Mohammed HE, Yamani M. Role of leukotriene inhibitors in the postoperative management of nasal polyps. ORL J Otorhinolaryngol Relat Spec. 2005;67(3):148-53. [Medline].

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Further Reading

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Keywords

surgical treatment of nasal polyps, nasal polyps, polyposis, chronic allergic rhinitis, chronic sinusitis, cystic fibrosis, nasal obstruction, persistent nasal discharge, rhinorrhea, sinus infection, anosmia, nasal polyposis, chronic rhinosinusitis

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Contributor Information and Disclosures

Author

Andrew Cheng, MD, Clinical Assistant Professor, Department of Otolaryngology-Head & Neck Surgery, New York Medical College
Andrew Cheng, 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, and Medical Society of the State of New York
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

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Department of Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

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: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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