Nasal Polyps
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Direct answer
Nasal polyps are pale, oedematous outgrowths of prolapsed sinonasal mucosa that present with nasal obstruction, hyposmia and watery rhinorrhoea. The two classical types are the single antrochoanal polyp, which arises from the maxillary antrum and prolapses into the choana, often in children and young adults, and the bilateral ethmoidal polyps of adults with chronic rhinosinusitis and allergy. Treatment is medical first — intranasal steroids — with endoscopic surgical removal for failed medical therapy or large obstructing polyps.
What you must remember
- Ethmoidal polyps: bilateral, multiple, grapelike masses prolapsing from the ethmoid mucosa in adults with chronic rhinosinusitis, allergic or non-allergic; associated with asthma and aspirin sensitivity — the triad of asthma, aspirin sensitivity and nasal polyposis is Samter triad.
- Antrochoanal (Killian's) polyp: usually single, arises from the maxillary antrum, extends through the accessory ostium into the nasal cavity and posteriorly into the choana and nasopharynx; presents in children and young adults with unilateral obstruction and a mass hanging behind the soft palate.
- Symptoms: progressive nasal obstruction, mouth breathing, hyposmia or anosmia, watery discharge, sneezing and headache; large polyps broaden the nose and are visible in the nostril.
- Examination: pale, semitranslucent, insensitive masses that do not bleed on touch — a crucial contrast with suspicious lesions.
- Investigation: diagnostic nasal endoscopy and computed tomography of the paranasal sinuses to define extent and origin; unilateral polyps in adults warrant imaging and histopathology to exclude tumour or inverted papilloma.
- Red flags in unilateral "polyps": bleeding, pain, orbital signs or an older patient — neoplasia, including juvenile angiofibroma in adolescent boys, must be excluded before any biopsy or surgery.
- Treatment: intranasal corticosteroid sprays as first line with a short oral steroid course to shrink disease (medical polypectomy); endoscopic polypectomy with functional endoscopic sinus surgery for refractory or extensive disease; bilateral polyps in a child demand evaluation for cystic fibrosis.
Common confusion
A polyp is not a turbinate — students record a normal inferior turbinate as a polyp; turbinates are pink and sensitive, polyps pale and insensitive. Also remember the teaching point that a "single polyp" in a child is an antrochoanal polyp until proved otherwise, while bilateral polyps in a child raise cystic fibrosis, and any unilateral polyp in an adult is a histology question, never a routine excision.
Exam-focused takeaway
For theory, define polyps, distinguish antrochoanal from ethmoidal types in a structured comparison, list red flags and then give medical and surgical treatment. In viva, expect Samter triad, the origin of the antrochoanal polyp and the significance of unilateral polyps. In the outpatient posting, examine every obstructed nose with a speculum and, when available, an endoscope, and present findings as laterality, number, colour and sensitivity — the four features examiners listen for.
Frequently asked questions
How do antrochoanal and ethmoidal polyps differ?
The antrochoanal polyp is single, arises from the maxillary antrum and prolapses to the choana in the young; ethmoidal polyps are multiple, bilateral and arise from ethmoid mucosa in adults with chronic rhinosinusitis.
What is Samter triad?
Asthma, aspirin sensitivity and nasal polyposis occurring together, indicating aspirin-exacerbated respiratory disease.
Why are unilateral polyps in adults suspicious?
Bleeding or painful unilateral masses may be inverted papilloma or malignancy, so imaging and histopathology are mandatory before surgery.
What is the first-line treatment of nasal polyps?
Intranasal corticosteroid sprays, with a short oral steroid course for bulkier disease; surgery is reserved for failure of medical therapy or complications.
What should bilateral polyps in a child suggest?
Cystic fibrosis, among other causes, and the child needs appropriate evaluation alongside ENT management.
What is medical polypectomy?
Shrinking polyps with a short course of oral corticosteroids combined with intranasal steroids, avoiding or delaying surgery in many patients.