Nasal polyps are among the most common causes of chronic nasal obstruction and loss of smell worldwide. Although they are non-cancerous (non-neoplastic), they can lead to significant discomfort, nasal congestion, and impaired breathing. These soft, painless growths typically form on the lining of your sinuses or nasal passages and can occur at any age—though they are more frequent in adults and those with chronic rhinosinusitis.
In this article, we will explore the two main types of nasal polyps—bilateral ethmoidal polyps and antrochoanal polyps—and cover their symptoms, clinical signs, and diagnostic and therapeutic pathways. The structure follows the illustrated poster to reinforce visual memory for students and clinical practitioners.
What Are Nasal Polyps?
Nasal polyps are non-neoplastic, edematous growths arising from the nasal or sinus mucosa, commonly resulting from chronic inflammation, allergies, or recurrent infections. Despite being benign, they can severely affect quality of life when untreated.
They are typically associated with:
- Allergic rhinitis
- Chronic rhinosinusitis
- Asthma
- Cystic fibrosis
- Aspirin sensitivity (Samter's triad)
Types of Nasal Polyps
There are two major clinical subtypes:
1. Bilateral Ethmoidal Polyps
- Arise from the ethmoid sinus.
- Often multiple, bilateral, and seen in allergic individuals.
- Common in adults.
- Tend to recur even after removal.
2. Antrochoanal Polyps
- Originate in the maxillary sinus (antrum) and extend into the choana.
- Typically unilateral and solitary.
- More commonly found in children and adolescents.
- Less likely to recur after surgical excision.
Symptoms of Nasal Polyps
The presence and progression of polyps are marked by a variety of respiratory and sensory symptoms. Based on the visual:
1. Multiple Polyps at Any Stage
Polyps can grow slowly over time and often go unnoticed until they reach a size that interferes with nasal airflow.
- They may initially be small and asymptomatic.
- As they enlarge, they can block sinus drainage and airflow.
2. Nasal Obstruction
One of the hallmark symptoms of nasal polyps.
- Patients often describe it as a “blocked nose” or “can’t breathe properly” through one or both nostrils.
- Worse at night and during seasonal allergy flares.
3. Loss of Sense of Smell (Anosmia)
The swelling and obstruction reduce olfactory nerve exposure, causing:
- Complete or partial loss of smell.
- May precede other symptoms and persist even after polyp removal in some cases.
4. Headache
- Results from sinus congestion and increased pressure.
- Often localized around the forehead, cheeks, or behind the eyes.
5. Mass Protruding from the Nostrils
In severe cases, a visible, fleshy mass may be seen protruding externally from the nasal opening.
- Soft and mobile on touch.
- May cause embarrassment or discomfort due to cosmetic appearance.
Clinical Signs of Nasal Polyps
The physical examination often confirms the diagnosis through anterior rhinoscopy or nasal endoscopy. Signs mentioned in the visual include:
1. Polyp Appears as a Smooth, Grape-like Mass
- Polyps are typically non-tender, shiny, and smooth in texture.
- Appear like translucent grapes hanging from the nasal walls.
2. Pale in Colour
Unlike inflamed nasal mucosa (which appears red), polyps are usually:
- Pale, bluish-grey, or yellowish.
- Indicative of chronic rather than acute inflammation.
3. Multiple and Bilateral
- Especially true for ethmoidal polyps.
- Distinguishes them from antrochoanal polyps, which are usually solitary and unilateral.
4. Nasal Cavity Shows Purulent Discharge
- Suggests secondary infection or sinusitis.
- Mucopurulent or foul-smelling discharge is often present in chronic cases.
Pathogenesis: Why Do Nasal Polyps Form?
The underlying mechanisms include:
- Chronic inflammation of nasal mucosa due to allergens, infections, or irritants.
- Repeated inflammation leads to mucosal edema, glandular hyperplasia, and extracellular matrix accumulation.
- The weakened mucosa protrudes into the nasal cavity, forming a polyp.
Key Triggers:
- Dust mites, pollen, mold
- Air pollution and smoking
- Viral upper respiratory infections
Diagnostic Workup
| Investigation | Purpose |
|---|---|
| Nasal Endoscopy | Visualizes location, size, and number of polyps |
| CT Scan (PNS) | Maps sinus anatomy, identifies obstruction |
| Allergy Testing | Identifies underlying allergic causes |
| Nasal Smear/Culture | Rules out bacterial or fungal infection |
| Biopsy (rare) | Done if malignancy suspected (unilateral, bleeding, firm) |
Differential Diagnosis
Nasal polyps must be differentiated from:
| Condition | Distinguishing Features |
|---|---|
| Hypertrophied turbinates | Red, congested, not mobile |
| Encephalocele | Pulsatile, reduces on pressure |
| Angiofibroma | Adolescent male, profuse bleeding |
| Inverted papilloma | Unilateral, may be malignant |
| Foreign body | Especially in children, associated with foul odor |
Treatment of Nasal Polyps
1. Medical Management
First-line treatment, especially in small to moderate polyps:
- Intranasal corticosteroids: Fluticasone, Mometasone
- Oral corticosteroids: For short-term reduction of large polyps
- Antihistamines: For allergic rhinitis
- Leukotriene inhibitors: Montelukast
- Saline nasal irrigation: Improves mucociliary clearance
Goal: Reduce size, relieve symptoms, prevent recurrence.
2. Surgical Management
Indicated when:
-
Polyps are large, recurrent, or unresponsive to medication
-
Associated with sinus infections, anatomical blockages
Types of Surgery:
| Procedure | Indication |
|---|---|
| Functional Endoscopic Sinus Surgery (FESS) | Gold standard for polyp removal |
| Polypectomy | Simple excision, often outpatient |
| Caldwell-Luc operation | Rare, for antrochoanal polyp in adults |
Post-op care includes nasal sprays, saline rinses, and steroid drops to reduce recurrence risk.
Complications if Untreated
Ignoring nasal polyps can lead to:
- Chronic sinusitis
- Recurrent respiratory infections
- Obstructive sleep apnea
- Facial deformity from large polyps
- Reduced quality of life due to anosmia and breathing difficulty
Prognosis and Follow-Up
- Nasal polyps often recur, especially in allergic individuals.
- Regular follow-up and compliance with corticosteroid therapy are essential.
- In some cases, lifelong management may be needed to maintain symptom control.
Patient Counseling Tips
Educating patients on the nature of their condition improves outcomes:
- Avoid known allergens and irritants like smoke and perfumes.
- Use prescribed nasal sprays regularly, even when asymptomatic.
- Practice steam inhalation and nasal hygiene.
- Monitor for symptoms of recurrence: nasal blockage, anosmia, or discharge.
Frequently Asked Questions (FAQs)
Q1. Can nasal polyps turn into cancer?
No. Nasal polyps are benign. However, any unilateral, bleeding, or firm mass should be evaluated for malignancy.
Q2. Are nasal polyps contagious?
No. They are not infectious or contagious. They result from inflammation, not pathogens.
Q3. Can nasal polyps cause snoring or sleep apnea?
Yes. Obstruction from large polyps may lead to snoring, mouth breathing, and obstructive sleep apnea.
Q4. Will allergy shots help with nasal polyps?
In allergic patients, immunotherapy may reduce inflammation and frequency of polyps.
Q5. Is surgery a permanent cure?
Not always. Polyps may recur. Post-op medical therapy is crucial to prevent regrowth.
Conclusion
Nasal polyps may seem harmless at first glance, but they can have far-reaching effects on respiratory health, sensory function, and quality of life. Recognizing early symptoms like nasal blockage, loss of smell, or headache, and observing key clinical signs like grape-like masses, can lead to early diagnosis and timely intervention.
