Nasal polyps
Nasal polyps are benign, typically bilateral outgrowths of edematous nasal mucosa driven by chronic mucosal inflammation, most often arising with chronic rhinosinusitis, aspirin-exacerbated respiratory disease, or cystic fibrosis. Unilateral polyps or a mass that does not respond to treatment must be biopsied to exclude tumor.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Benign sinonasal outgrowths: nasal polyps are benign outgrowths of nasal mucosa and represent the most common tumors of the nasal cavity.
- Epidemiology
Associated with chronic rhinosinusitis: chronic sinusitis is the most common condition associated with nasal polyps, and polyp formation is one recognized pattern of chronic sinonasal inflammation.
- Risk factors
Chronic rhinosinusitis: ongoing sinonasal inflammation, whether allergic or nonallergic, is the dominant predisposing condition.
- Pathophysiology
Chronic eosinophilic mucosal inflammation: persistent inflammation of the sinonasal mucosa, most often eosinophil-predominant, leads to interstitial edema of the lamina propria.
- Clinical features
Nasal obstruction: the dominant symptom, from progressive mechanical blockage by polyp tissue.
- Differential diagnosis
Nasopharyngeal carcinoma: presents with unilateral nasal obstruction, discharge, and epistaxis rather than the bilateral pattern of inflammatory polyps; requires biopsy to distinguish from an inflammatory polyp.
- Diagnosis
Diagnosis is established by direct visualization: nasal polyps are diagnosed by seeing pale, glistening, semi-translucent polypoid tissue in the nasal cavity; when accompanying chronic…
- Management
First, intranasal corticosteroids for all patients: start fluticasone propionate nasal spray 2 sprays (50 mcg/spray) per nostril once daily as first-line maintenance therapy; continue indefinitely…
- Complications
Recurrence after surgery: polyps frequently recur after polypectomy without continued intranasal corticosteroid maintenance.
- Prognosis
Chronic, relapsing course: nasal polyps are a chronic condition that tends to recur, especially when the underlying inflammatory driver (AERD, CF, allergic fungal sinusitis) is not controlled.
- Prevention
Maintenance intranasal corticosteroid after treatment: continue fluticasone propionate nasal spray 2 sprays (50 mcg/spray) per nostril once daily indefinitely after medical or surgical treatment…
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Chronic rhinosinusitis
Chronic rhinosinusitis is inflammation of the paranasal sinuses lasting 12 weeks or longer, confirmed by nasal endoscopy or CT, and treated first with intranasal corticosteroids and saline irrigation before escalation to antibiotics, oral steroids, biologics, or surgery.
- Acute rhinosinusitis
Acute rhinosinusitis is inflammation of the nasal cavity and paranasal sinuses lasting up to 4 weeks, presenting with purulent nasal discharge plus nasal obstruction or facial pain/pressure/fullness. Most cases are viral and treated with acetaminophen/ibuprofen plus nasal saline irrigation alone; a minority are bacterial, identified by persistence beyond 10 days, a biphasic worsening course, or severe onset, and treated with amoxicillin-clavulanate 875/125 mg PO every 12 hours for 5 to 7 days.
- Allergic rhinitis
Allergic rhinitis is an IgE-mediated inflammation of the nasal mucosa causing sneezing, rhinorrhea, congestion, and itch on allergen exposure, classified as seasonal or perennial. Diagnosis is clinical, supported by skin or specific IgE testing to identify allergens, and treatment is allergen avoidance with intranasal corticosteroids first-line, escalating to combination therapy and allergen immunotherapy.
- Asthma
Asthma is a chronic inflammatory airway disorder causing episodic, reversible airflow obstruction confirmed by spirometry or bronchial challenge testing. Management is a stepwise ladder led by inhaled glucocorticoids plus as-needed SABA or ICS-formoterol, escalating to biologics for severe type 2-high disease, with an oral glucocorticoid burst and frequent SABA for exacerbations.
- Cystic fibrosis
Cystic fibrosis is an autosomal recessive CFTR chloride-channel disorder causing thick secretions, bronchiectasis, and exocrine pancreatic insufficiency, diagnosed by elevated sweat chloride confirmed with CFTR genotyping and managed with CFTR modulators, airway clearance, and pancreatic enzyme replacement.
- Nasopharyngeal carcinoma
Nasopharyngeal carcinoma is a squamous cell carcinoma of the nasopharynx strongly associated with Epstein-Barr virus and especially prevalent in Southeast Asia. It often presents late with a painless neck mass, unilateral otitis media, or cranial nerve palsies, and treatment centers on radiation, often combined with chemotherapy.
- Epistaxis
Nosebleed from the anterior Kiesselbach plexus or the posterior sphenopalatine artery territory, managed with a stepwise escalation from first aid through cautery, packing, and, for refractory bleeding, embolization or surgical ligation.