Category: For Allergy Fellows > Topics for Medical Professionals  

Nasal Polyps

Nasal polyps are the final product of divergent pathophysiologic processes.  Nasal polyps develop in response to proinflammatory cytokines.  Clinically, the presence of polyps in chronic sinusitis patients is a marker for greater burden of sinus disease, hyposmia/anosmia, NSAID sensitivity and asthma.  Pathologically, nasal polyps may be divided by the presence or relative absence of eosinophils.  Blood and tissue eosinophilia also correlates with nasal polyp size and extent of mucosal disease.  Surgical and medical therapy of nasal polyps leads to improved asthma in many patients.

What we know about nasal polyps so far and how it relates to treatment and prognosis:

  • Nasal Polyps in Aspirin Triad Asthma (Samter’s Triad) tend to be severe but also may respond very well to aspirin desensitization.  Without desenstization patients experience polyp recurrence and on average require repeat sinus surgery in 2 years.  For about 2/3 of patients undergoing ASA desensitization there is significant delay in polyp recurrence and asthma control also improves.
  • Combined medical and surgical Treatment of Nasal Polyps is associated with improved asthma.  Surgical therapy alone in asthma patients with nasal polyps is not associated with the same improvement.
  • Smoking is associated with nasal polyps.  This refers to both history of smoking and sometimes a single exposure to 2nd hand smoke can cause a flare.
  • Perennial allergic rhinitis to dust mites and mold is more common in nasal polyp patients but allergy immunotherapy has little impact on the progression of polyps or sinus disease.
  • Nasal steroids are effective for many nasal polyp patients but the most severe patients require either oral steroids or nebulized nasal steroids (long term safety studies of nebulized nasal steroids have not been done).
  • Nasal polyps are seen in some medical conditions including cystic fibrosis, ciliary dyskinesia, Churg-Strauss
  • The amount of eosinophils in Nasal Polyps is related to eosinophilia of the peripheral blood, but not to elevated serum IgE.

Factors hypothesized to contribute to nasal polyps:

  • infection
  • allergic rhinitis
  • endotoxins of Staphylococcus aureus
  • fungal antigens

Nasal Polyps maybe steroid sensitive:

Banerji A, Piccirillo JF, Thawley SE.    Chronic rhinosinusitis patients with polyps or polypoid mucosa have a greater burden of illness.  Am J Rhinol. 2007 Jan-Feb;21(1):19-26

Bryson JM, Tasca RA, Rowe-Jones JM. Local and systemic eosinophilia in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis with and without polyposis.  Clin Otolaryngol Allied Sci. 2003 Feb;28(1):55-8.

Houser SM, Keen KJ. Laryngoscope. The role of allergy and smoking in chronic rhinosinusitis and polyposis.2008 Sep;118(9):1521-7

Kanowitz SJ, Batra PS, Citardi MJ. Topical budesonide via mucosal atomization device in refractory postoperative chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2008 Jul;139(1):131-6

Ragab S, Scadding G, Lund V et al. Treatment of chronic rhinosinusitis and its effects on asthma. Eur Respir J 2006; 28:68-74

Staikūniene J, Vaitkus S, Japertiene LM, Ryskiene S.  Association of chronic rhinosinusitis with nasal polyps and asthma: clinical and radiological features, allergy and inflammation markers. Medicina 2008;44(4):257-65.

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