Nasal polyps

What it is

Nasal polyps are benign lesions that originate from any portion of the nasal mucosa or paranasal sinuses, due to chronic inflammation. They mostly arise from the ethmoid cells and prolapse into the nose via the middle meatus. They are frequently associated with chronic sinusitis, asthma and aspirin sensitivity, and that combination of asthma, aspirin sensitivity and nasal polyps is known as Samter's triad.

How it presents

• Progressive nasal obstruction
• Rhinitis: blocked or runny nose and sneezing
• Rhinorrhoea and post-nasal drip
• Recurrent sinusitis, from osteomeatal obstruction
• Hyposmia and anosmia

How it is diagnosed

Anterior rhinoscopy shows pale, grey polypoid masses. They are insensitive and mobile and do not bleed. A CT scan is used to evaluate the sinuses for inflammation.

The thing it has to be told apart from is the inferior turbinate, and the two are set side by side. The nasal polyp is Pale/Grey, Insensate on probing and Mobile on probing; the inferior turbinate is Pink, Sensate on probing and Immobile on probing. The endoscopic views run Normal nose, Inferior turbinate hypertrophy, and Nasal polyp.

The grades run by how far down the polyps reach:

• Grade 1: smallest, within the middle meatus
• Grade 2: polyps within the middle meatus reaching the inferior border of the middle turbinate
• Grade 3: below the inferior edge of the middle turbinate but not below the inferior edge of the inferior turbinate
• Grade 4: polyps filling up the nasal cavity

Unilateral polyps are a red flag. Polyps due to rhinosinusitis are usually bilateral, so it is important to refer a unilateral polyp to an ENT doctor to exclude malignancy.