Education And Debate

Fortnightly Review: Diagnosis and treatment of nasal polyps

BMJ 1995; 311 doi: http://dx.doi.org/10.1136/bmj.311.7017.1411 (Published 25 November 1995) Cite this as: BMJ 1995;311:1411
  1. Valerie J Lund, professor in rhinologya
  1. aUniversity College London Medical School, Institute of Laryngology and Otology, London WC1X 8DA

    Summary points

    • The aetiology of nasal polyposis is unknown though the condition is more common in certain medical disorders

    • Nasal polyps must be distinguished from more serious pathology such as neoplasia

    • Treatment is a combination of surgery and drugs; drug treatment is usually required long term

    poly-pous many-footed

    Nasal polyps have been a medically recognised condition since the time of the ancient Egyptians and their removal with a snare was described by Hippocrates, a method which persisted well into the second half of the 20th century.1 Interestingly, only man and the chimpanzee are affected by this condition.

    Aetiology

    No single predisposing disease can be implicated in the formation of polyps, though they may be associated with several other diseases (table), notably non-allergic (intrinsic) asthma and aspirin intolerance or sensitivity. No evidence exists, however, for an allergic origin.2 In allergic rhinitis the prevalence of symptomatic nasal polyps is low (1.5%), similar to that in the normal population (1%). Since the advent of nasal endoscopy, however, any area of mucosal content may be associated with localised oedema or “polypoid” change, particularly in the middle meatus (fig 1).3 It is not known whether this change is the progenitor of gross polyposis (fig 2) and, if so, what factors determine progression of the disease process. Nasal polyps seem to be far more common than previous clinical studies have shown. Larsen et al reported that, with careful endoscopic examination of cadavers, a quarter of individuals had polyps originating in the sinus ostia or recesses of the lateral nasal wall without a history of sinonasal disease.4

    View this table:
    FIG 1

    Endoscopic photograph showing localised area of polypoid change where mucosa of middle turbinate touches lateral wall in left nasal cavity

    Fig 2

    Endoscopic photograph showing more extensive polyposis in the right middle meatus between middle turbinate and lateral wall

    Polyps do not …

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