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Chapter 7: Nasal polyps.
MedLine Citation:
PMID:  22794680     Owner:  NLM     Status:  In-Data-Review    
Nasal polyps are inflammatory outgrowths of paranasal sinus mucosa caused by chronic mucosal inflammation that typically arise from the middle meatus and ethmoid region. The main symptoms of nasal polyps are perennial nasal congestion, nasal obstruction, and anosmia or hyposmia. Unlike patients with chronic rhinosinusitis (CRS) without nasal polyps who present with headache and facial pain, patients with nasal polyps typically do not complain of those symptoms. Nasal polyps appear as semitranslucent, pale gray growths in the nasal cavity in contrast to pink or erythematous adjacent mucosa. Nasal polyps occur more frequently in patients with persistent asthma, aspirin-exacerbated respiratory disease (AERD), CRS, and cystic fibrosis. Children with nasal polyps should be evaluated for cystic fibrosis. Churg-Strauss syndrome and ciliary dyskinesia also may be associated with nasal polyps. Nasal polyps have increased numbers of activated eosinophils, mast cells, and IgE. Staphylococcal superantigens may play a role in the Th2 type of chronic eosinophilic inflammation observed in nasal polyps. Dysfunction of the epithelial barrier in nasal polyps causing reduced levels of antimicrobial proteins has been described. Topical nasal steroids are the treatment of choice. They significantly decrease polyp size, nasal congestion, rhinorrhea, and increase nasal airflow. Short courses of oral steroids may be needed to reduce polyp size followed by maintenance therapy with intranasal steroids. Surgery is reserved for cases when polyps cause severe obstruction, recurrent sinusitis, and for patients who have failed medical therapy. Aspirin desensitization may decrease the requirement for polypectomies and sinus surgery in patients with AERD.
Mary S Georgy; Anju T Peters
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Allergy and asthma proceedings : the official journal of regional and state allergy societies     Volume:  33 Suppl 1     ISSN:  1539-6304     ISO Abbreviation:  Allergy Asthma Proc     Publication Date:    2012 May-Jun
Date Detail:
Created Date:  2012-07-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9603640     Medline TA:  Allergy Asthma Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  22-3     Citation Subset:  IM    
Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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