EN4.27 | Nasal Polyps — Summary & Reflection

KEY TAKEAWAYS

Nasal polyps are oedematous outgrowths of the nasal mucosa arising from chronic eosinophilic inflammation of the sinonasal mucosa. Bilateral ethmoidal polyps (pale, insensitive, grape-like masses in the middle meatus) are the commonest type, strongly associated with allergic rhinitis, asthma, and aspirin sensitivity (Samter's triad), and present with bilateral nasal obstruction, anosmia, and rhinorrhoea in adults. The antrochoanal (Killian's) polyp is unilateral, arises from the maxillary antrum, extends to the choana, and is commoner in children. A unilateral nasal mass must never be assumed to be a simple polyp — the differential includes JNA (adolescent male + recurrent epistaxis + no biopsy), inverted papilloma, meningoencephalocele, and malignancy. Investigation is by anterior rhinoscopy and nasal endoscopy; CT paranasal sinuses (Lund-Mackay scoring) is mandatory for surgical planning. Management is stepwise: topical corticosteroids (first line), short-course oral steroids for severe disease, and FESS for medically refractory cases. Post-operative topical corticosteroids are mandatory to reduce recurrence. Biologics (dupilumab) are reserved for severe uncontrolled CRSwNP. Nasal polyps in children warrant exclusion of cystic fibrosis.

REFLECT

A patient with bilateral nasal polyps tells you she has seen three different doctors over two years and has been prescribed antibiotics each time without lasting benefit. She is frustrated and asks whether 'the polyps are coming back because the doctors are not treating the real problem.' How would you explain the nature of her condition — specifically the concept of a chronic inflammatory disease with a tendency to recur — and what you can realistically promise her about the long-term outcome with optimal treatment? Reflect on how you would balance honest prognostic counselling with maintaining her motivation to adhere to a long-term treatment plan that includes daily nasal sprays and regular follow-up.