Nasal Polyps
Nasal polyps are benign chronic inflammatory growths of the sinonasal mucosa, usually associated with chronic sinusitis / rhinosinusitis.
This updated UKMLA guide to nasal polyps is based on NHS Tayside ENT guidance, which covers causes, symptoms, diagnosis, red flags and management.
Causes and Risk Factors
Most common: chronic sinusitis [Ref]
Other associations: [Ref]
- Cystic fibrosis
- Cystic fibrosis should be considered as the underlying cause if a young patient presents with refractory nasal polyps
- Aspirin-exacerbated respiratory disease (Samter’s triad – asthma, polyps and aspirin/NSAIDs hypersensitivity)
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
Young people with allergic rhinitis can occasionally be misdiagnosed as having polyps.
Clinical Features and Diagnosis
Nasal polyps are primarily a clinical diagnosis
Nasal polyps classically present with slow, progressive [Ref]
- Nasal obstruction / congestion
- Rhinorrhoea
- Reduced sense of smell
Nasal polyps appearance on anterior rhinoscopy: [Ref]
- Pale (yellow-grey colour), translucent
- Insensate (no sensation on probing – patient doesn’t feel anything)
- Mobile
- Arises from the lateral nasal wall (middle meatus)
Red flag: unilateral nasal polyp
- Nasal polyps are almost always bilateral
- Unilateral polyp should raise suspicion for malignancy or alternative diagnoses → urgent ENT referral
Nasal Polyp vs Turbinate Hypertrophy vs Septal Haematoma
Top 3 causes of intranasal masses / swellings:
| Feature | Nasal polyp | Turbinate hypertrophy | Septal haematoma |
|---|---|---|---|
| Typical cause | Chronic sinusitis | Allergic rhinitis | Trauma |
| Location | Lateral nasal wall (middle meatus) | Lateral nasal wall (turbinate) | Medial nasal wall (nasal septum) |
| Appearance | Pale, translucent | Red / pink (swollen mucosa) | Red / purple bulge |
| Consistency | Soft | Firm | Fluctuant (blood-filled) |
| Mobility | Mobile | Immobile | Immobile |
| Sensation | Insensitive | Sensitive | Very tender |
| Response to steroids | Improves | Do NOT respond to any medications | |
| Response to decongestants | No response | Shrinks | |
| Management | Intranasal corticosteroids | Intranasal corticosteroids
Treat underlying cause (usually allergic rhinitis) |
ENT emergency – urgent incision and drainage |
Management
1st line and mainstay: intranasal corticosteroids
- Typically a long-term nasal steroid spray (e.g. mometasone)
- Fluticasone nasal drops for those with poor nasal air entry – under specialist recommendation
If there is poor response to intranasal corticosteroids → refer to ENT for consideration of [Ref]
- Oral steroids
- Surgical interventions (e.g. functional endoscopic sinus surgery)
- Biologics (e.g. omalizumab, mepolizumab)