Nasal polyps are growths of the nasal mucosa that can occur in the nasal cavity or sinuses. They are often associated with inflammation, particularly with chronic rhinitis. They grow slowly and gradually obstruct the nasal passage.
Polyps are usually bilateral. Unilateral nasal polyps are a red flag and should raise suspicions of tumours.
TOM TIP: If you remember one thing about nasal polyps, remember that unilateral polyps are concerning for malignancy and require a specialist referral for assessment.
Associations
Nasal polyps are associated with several conditions:
- Chronic rhinitis or sinusitis
- Asthma
- Samter’s triad (nasal polyps, asthma and aspirin intolerance/allergy)
- Cystic fibrosis
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
Presentation
Nasal polyps may be found on examination in patients presenting with:
- Chronic rhinosinusitis
- Difficulty breathing through the nose
- Snoring
- Nasal discharge
- Loss of sense of smell (anosmia)
You can examine the nose with a nasal speculum, which holds the nostrils open. Alternatively, you can use an otoscope with a large speculum attached. A specialist can perform nasal endoscopy to visualise the nasal cavity in detail to assess any polyps.
Nasal polyps appear as round pale grey/yellow growths on the mucosal wall.
Management
Unilateral polyps should be referred for specialist assessment to exclude malignancy.
Medical management involves intranasal topical steroid drops or spray.
Surgical management is used where medical treatment fails. This involves removing the polyps:
- Intranasal polypectomy is used where the polyps are visible close to the nostrils
- Endoscopic nasal polypectomy is used where the polyps are further in the nose or the sinuses
Last updated July 2021