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Nasal Polyps

by Marvin P. Fried, MD

Nasal polyps are fleshy outgrowths of the nasal mucosa that form at the site of dependent edema in the lamina propria of the mucous membrane, usually around the ostia of the maxillary sinuses.

Allergic rhinitis, acute and chronic infections, and cystic fibrosis all predispose to the formation of nasal polyps. Bleeding polyps occur in rhinosporidiosis. Unilateral polyps occasionally occur in association with or represent benign or malignant tumors of the nose or paranasal sinuses. They can also occur in response to a foreign body. Nasal polyps are strongly associated with

  • Aspirin allergy

  • Sinus infections

  • Asthma

Symptoms include obstruction and postnasal drainage, congestion, sneezing, rhinorrhea, anosmia, hyposmia, facial pain, and ocular itching.

Diagnosis generally is based on physical examination. A developing polyp is teardrop-shaped; when mature, it resembles a peeled seedless grape.

Treatment

  • Topical corticosteroid spray

  • Sometimes surgical removal

Corticosteroids (eg, mometasone [30 mcg/spray], beclomethasone [42 mcg/spray], flunisolide [25 mcg/spray] aerosols), given as 1 or 2 sprays bid in each nasal cavity, may shrink or eliminate polyps, as may a 1-wk tapered course of oral corticosteroids. Surgical removal is still required in many cases. Polyps that obstruct the airway or promote sinusitis are removed, as are unilateral polyps that may be obscuring benign or malignant tumors. However, polyps tend to recur unless the underlying allergy or infection is controlled. After removal of nasal polyps, topical beclomethasone or flunisolide therapy tends to retard recurrence. In severe recurrent cases, maxillary sinusotomy or ethmoidectomy may be indicated. These procedures are usually done endoscopically.

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Drugs Mentioned In This Article

  • Drug Name
    Select Trade
  • No US brand name
  • AEROSPAN HFA
  • BECONASE
  • ELOCON, NASONEX

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