eMedicine Specialties > Pediatrics: Surgery > Otolaryngology

Nasal Polyps: Follow-up

Author: John E McClay, MD, Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School
Contributor Information and Disclosures

Updated: Oct 22, 2008

Follow-up

Further Inpatient Care

  • Historically, children diagnosed with cystic fibrosis (CF) already had digestive and pulmonary disease and were the children with the more severe form of disease. These children were often treated with intravenous antibiotics directed at the most common pathogens found in the lungs and the sinuses (eg, Pseudomonas aeruginosa, Staphylococcus aureus), both preoperatively and postoperatively. Additionally, these children had pulmonary toilet to increase their lung function in the perioperative period, including intravenous steroids, percussion therapy, and inhaled bronchodilators. Much of this process can now be performed on an outpatient basis, depending on the severity of the associated disease.
  • For patients with severe asthma and polyposis requiring surgery, postoperative admission for observation of respiratory compromise or spasm is determined on an individual basis.
  • Outpatient surgery is usually performed for older children undergoing endoscopic sinus surgery (ESS) for nasal polyposis without coexisting medical conditions.

Further Outpatient Care

  • Closely monitor children with benign multiple nasal polyps, whatever the cause, because recurrence is likely, whether medically or surgically treated. Postoperative follow-up should occur 3-4 times the first month to monitor healing of the sinus cavities; frequency depends on the patient's own geographic location and symptoms.
  • A patient with CF can be monitored symptomatically because surgery is not performed until these patients are symptomatic, even if nasal polyposis is seen on CT scan or nasal endoscopy. Certainly, each patient is treated on an individual basis.
  • For polyps associated with allergic fungal sinusitis (AFS), close follow-up by an otolaryngologist is recommended until the patient is deemed free of disease, which may be several years or more.
  • Any accumulation of fungus may accelerate the antigenic process, which causes symptoms and disease to recur. Recurrence is especially common for polyps, which may be controlled more simply and effectively if recognized early.
  • Small nasal polyps are recognized early on a routine follow-up in patients with benign multiple nasal polyps.
  • Other diseases may be treated medically or with smaller surgical procedures. For diseases resulting in nasal polyps other than benign multiple nasal polyps, the need for inpatient or outpatient care is determined by the extent of disease, symptoms and situation of the patient, and associated medical conditions.

Inpatient & Outpatient Medications

Deterrence/Prevention

Complications

  • Massive polyposis or a single large polyp (eg, an antral-choanal polyp [Media files 4-12]) that obstructs the nasal cavities and/or nasopharynx can cause obstructive sleep symptoms and chronic mouth breathing. Rarely, massive polyposis, observed in CF (Media files 1-3) and in AFS (Media file 41) can alter the craniofacial structure. This can result in proptosis, hypertelorism, and diplopia (see Media files 45-46).
  • In an article submitted for publication, the author reported that 40% of children (compared with 10% of adults) with AFS presented with craniofacial abnormalities. Massive polyposis rarely causes enough extrinsic compression on the optic nerve to decrease visual acuity. One study reported that 3 of 82 patients with AFS had vision changes from compression of the optic nerve in the sphenoid sinus that resolved over time with removal of disease. However, because these polyps are slow growing, they usually cause no neurological symptoms, even when they extend into the intracranial cavity.

Prognosis

  • Polyposis recurrence is common following treatment with medical or surgical therapy if multiple benign polyps are present (see Surgical Care). Single large polyps (eg, antral-choanal polyps) are less likely to recur. The literature contains sparse data comparing treatments.

Patient Education

  • Educating patients about the chronicity of the disease is important to make them aware of the recurrent nature of the problem.

Miscellaneous

Medicolegal Pitfalls

Unfortunately, many processes that affect the nasal cavity cause the same symptoms. Frequent upper respiratory tract infections, allergic rhinitis, nonallergic rhinitis, chronic sinusitis, recurrent acute sinusitis, adenoid hypertrophy, and chronic adenoiditis often create symptoms similar to those caused by nasal polyps or tumors. Thus, nasal polyps or tumors may be present for some time before being diagnosed, possibly leading the patient or the patient's parents to assume a delayed diagnosis.

This is a difficult problem for physicians and must be delicately handled by all caregivers. However, failure to recognize signs and symptoms of advanced disease that affect other areas of the face, head, or neck (eg, paresthesias of the face, alteration of the craniofacial structure, significant persistent epistaxis, neurological symptoms, cranial nerve abnormalities) could expose patients to complications that could have been avoided if those symptoms were discovered earlier.

 


More on Nasal Polyps

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

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Further Reading

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Contributor Information and Disclosures

Author

John E McClay, MD, Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School
John E McClay, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Orval Brown, MD, Director of Otolaryngology Clinic, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas
Orval Brown, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Medical Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Alan D Murray, MD, Pediatric Otolaryngologist, ENT for Children; Full-Time Staff, Medical City Dallas Children's Hospital; Consulting Staff, Department of Otolaryngology, Medical Center of Lewisville, Children's Medical Center at Dallas, Cook Children's Medical Center; Full-Time Staff, Texas Pediatric Surgery Center, The Pediatric Surgery Center
Alan D Murray, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Surgeons, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Glenn C Isaacson, MD, FACS, FAAP, Professor of Otolaryngology-Head and Neck Surgery and Pediatrics, Temple University School of Medicine
Glenn C Isaacson, MD, FACS, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society of Pediatric Otolaryngology, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Covidien Honoraria Consulting

 
 
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