nasal polyp
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Etiology
- asthma
- aspirin sensitivity
- allergic fungal sinusitis
- cystic fibrosis
- Churg-Strauss syndrome
Epidemiology
- more common in adults
Clinical manifestations
- may be asymptomatic
- stuffy nose blocking nasal passages
- described as pale mucoid masses filling nasal cavity upon rhinoscopy[10]
- rhinitis
- postnasal drip
- anosmia
- dysgeusia (loss of sense of taste)
- facial pain or headache
- snoring
Laboratory
- nasal swears
Diagnostic procedures
- nasal & sinus endoscopy with biopsy
- pseudostratified epithelium is usually found
- eosinophils may be present
Radiology
- CT of paranasal sinuses without contrast[8]
- coronal CT with 3-4 mm cuts
- appropriate soft tissue & bone window
- rule out malignancy, identify additional nasal polyp
- identify presence & extent of chronic rhinosinusitis
Complications
- frequent or chronic sinusitis
- obstructive sleep apnea
- altered facial structure leading to diplopia or wide-set eyes (cystic fibrosis)
Management
- nasal glucocorticoids (initial treatment of choice)[10]
- oral glucocorticoids are the most effective[8]
- add-on therapy with dupilumab may be an effective for patients with nasal polyposis insufficiently responsive to nasal glucocorticoids[4][5]
- omalizumab may be of benefit[6]
- surgery:
- polypectomy
- endoscopic sinus surgery
- good short-term relief, but minimally effective at 1 year[7]
More general terms
More specific terms
References
- ↑ Nasal polyps: Mayo Clinic http://www.mayoclinic.com/health/nasal-polyps/DS00498
- ↑ Archer SM eMedicine: Nasal polyps, Nonsurgical treatment http://emedicine.medscape.com/article/861353-overview
- ↑ McClay JE and Isaacson GC eMedicine: Nasal Polyps http://emedicine.medscape.com/article/994274-overview
- ↑ 4.0 4.1 Bachert C, Mannent L, Naclerio RM et al Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. JAMA. 2016 Feb 2;315(5):469-479. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26836729
- ↑ 5.0 5.1 Bachert C, Han JK, Desrosiers M et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): Results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet 2019 Sep 19; S0140-6736(19)31881-1; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31543428
Stevens WW. A new treatment for chronic rhinosinusitis with nasal polyps. Lancet 2019 Sep 19; S0140-6736(19)32133-6; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31543427 - ↑ 6.0 6.1 Gevaert P et al. Efficacy and safety of omalizumab in nasal polyposis: 2 randomized phase 3 trials. J Allergy Clin Immunol 2020 Sep; 146:595 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32524991 Free article https://www.jacionline.org/article/S0091-6749(20)30752-1/fulltext
- ↑ 7.0 7.1 Lourijsen ES et al. Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: A multicentre, randomised, controlled trial. Lancet Respir Med 2022 Apr; 10:337. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35012708 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00457-4/fulltext
- ↑ 8.0 8.1 8.2 Archer SM, Meyers AD Nonsurgical Treatment of Nasal Polyps. Medscape. April 1, 2021 https://emedicine.medscape.com/article/861353
- ↑ NEJM Knowledge+ Allergy/Immunology
- ↑ 10.0 10.1 10.2 NEJM Knowledge+ Otolaryngology