Nasal PolypsNasal PolypsBy Alex Pearce-SmithBy Alex Pearce-Smith

True of False?True of False? More common in men?More common in men? Equal gender incidence in asthmatics?Equal gender incidence in asthmatics? More common in Afro-carribeans?More common in Afro-carribeans? Sensitive to touch?Sensitive to touch? Common in children?Common in children? Usually bilateral?Usually bilateral? 20% recurr after surgery?20% recurr after surgery?

Nasal PolypsNasal Polyps

BackgroundBackground Most commonly seen in middle meatus.Most commonly seen in middle meatus. Eosinophil-rich oedematous wall Eosinophil-rich oedematous wall

characterised by Goblet cell characterised by Goblet cell hyperplasia.hyperplasia.

Uncertain pathogenesis but linked to Uncertain pathogenesis but linked to chronic infection and inflammation, chronic infection and inflammation, allergy AN dysfunction and genetics. allergy AN dysfunction and genetics.

Maybe single or multiple.Maybe single or multiple.

Incidence/PrevalanceIncidence/Prevalance Approx 2% incidence of polyps.Approx 2% incidence of polyps. Rare in children and declines after Rare in children and declines after

60.60. Males 2-4:1 Females (except Asthma Males 2-4:1 Females (except Asthma

1:1)1:1) Prevalance – 1% adults – 0.1% Prevalance – 1% adults – 0.1%

children.children. No racial predilectionNo racial predilection

AssociationsAssociations Infective Sinusitis – Staph, Strep, Infective Sinusitis – Staph, Strep,

Bacteroides, Pseudomonas A,Bacteroides, Pseudomonas A, C.F. – if 16 or under consider this. Polyps C.F. – if 16 or under consider this. Polyps

found in upto 48% of children with CF.found in upto 48% of children with CF. Asthma – upto 50% prevalance.Asthma – upto 50% prevalance. Kartageners, Churg-Strauss, Primary Kartageners, Churg-Strauss, Primary

ciliary diskinesia.ciliary diskinesia. Not associated with Allergic Rhinitis!Not associated with Allergic Rhinitis!

PresentationPresentation Nasal airway obstruction.Nasal airway obstruction. Watery Rhinorrhoea, Post-nasal drip.Watery Rhinorrhoea, Post-nasal drip. Obstructive sleep symptoms/snoring.Obstructive sleep symptoms/snoring. Anosmia.Anosmia. Chronic mouth breathing.Chronic mouth breathing. Samster’s Triad – Samster’s Triad –

polpys+asthma+aspirin sensitivity.polpys+asthma+aspirin sensitivity.

ExaminationExamination Distinguish from inferior turbinate Distinguish from inferior turbinate

as grey, able to get between as grey, able to get between them and the side of the nose them and the side of the nose and insensitive.and insensitive.

May be seen coming down into May be seen coming down into the oropharynx.the oropharynx.

Usually BilateralUsually Bilateral

Sinister Sinister Signs/SymptomsSigns/Symptoms Unilateral – consider cancer.Unilateral – consider cancer. Bleeding/CrustingBleeding/Crusting Eye symptoms Eye symptoms Severe unilateral frontal Severe unilateral frontal

headache.headache. Meningitis sx or focal neurology.Meningitis sx or focal neurology.

ManagementManagement Referral – unilateral, children etc.Referral – unilateral, children etc. Review associated diseases.Review associated diseases. Education as to recurring nature.Education as to recurring nature. Medical first line.Medical first line. Aim of treatment is to relieve Aim of treatment is to relieve

obstruction, restore olfaction, obstruction, restore olfaction, improve drainage.improve drainage.

Medical Medical Topical corticosteroids – Mometasone, Topical corticosteroids – Mometasone,

Fluticasone (safe in children). NB side-Fluticasone (safe in children). NB side-effects. As nasal spray –this may be effects. As nasal spray –this may be used continuously to prevent recurrence used continuously to prevent recurrence but at least 3M trial recommended) .but at least 3M trial recommended) .

Step 2 – Betnesol drops – 2 drops TDS Step 2 – Betnesol drops – 2 drops TDS each nostril for a month (NB equiv 0.5mg each nostril for a month (NB equiv 0.5mg prednisolone and caution in children).prednisolone and caution in children).– http://www.derbyshirecountypct.nhs.uk/contehttp://www.derbyshirecountypct.nhs.uk/conte

nt/files/Clinical%20Guidelines/Nasal%20Polypnt/files/Clinical%20Guidelines/Nasal%20Polyposis%20Guideline%2005(12).pdfosis%20Guideline%2005(12).pdf

Oral steroids – specialist advice.Oral steroids – specialist advice.

SurgicalSurgical Alongside medical management if Alongside medical management if

unsuccessful.unsuccessful. Either polypectomy or Either polypectomy or

ethmoidectomy.ethmoidectomy. Recurrence common – 60% have Recurrence common – 60% have

repeat procedure within 5 yrs.repeat procedure within 5 yrs. Less effective in patients with Less effective in patients with

concurrent asthma.concurrent asthma.

True or False?True or False? More common in men?More common in men? Equal gender incidence in asthmatics?Equal gender incidence in asthmatics? More common in Afro-carribeans?More common in Afro-carribeans? Sensitive to touch?Sensitive to touch? Common in children?Common in children? Usually bilateral?Usually bilateral? 20% recurr after surgery?20% recurr after surgery?

Questions?Questions?