###### Created: 2023-10-18 10:20 ###### Areas & Topics: #medicine ###### Note Type: #permanent ###### Connected to: [[]] - The nose has three main areas which are the nasal vestibule (the inside of the nostrils), the nasal cavity (the main space inside the nose) and the olfactory region (where olfactory cells at the top of the nose detect smells). - These regions are differentiated by where the epithelium changes. - In patients with nasal polyps, the cells of the mucosa inside the nose grow larger than normal and form small outgrowths on the inner surfaces of the nose. - This mean that nasal polyps are typically described as benign inflammatory and hyperplastic growths of the sinonasal mucosa. - Nasal polyps are classified as either localised, diffuse or systemic depending on the aetiology. - Systemic nasal polyps are those which are caused by a systemic condition or disease that have a nasal manifestation. ### Aetiology - Generally, nasal polyps (especially localised polpys) arise from a mixture of T-helper 2 cell-driven eisopnophilia, IgE inflammation and high levels of interleukin 5. - These changes are often associated with environmental changes and/or allergies. - In some cases, such as in patients with [[Cystic Fibrosis]], this inflammation is more neutrophil driven and can be in the absence of allergic stimuli (which is why it is recommended to investigate young people presenting with recurrent nasal polyposis for [[Cystic Fibrosis]]). - Examples of conditions which include nasal polyps include [[Eosinophilic Granulomatosis with Polyangiitis (EGPA)]], formerly known as Churg-Strauss syndrome and [[Cystic Fibrosis]]. - It is thought that there may be a genetic link to development of nasal polyps as well but this is not currently well known. ### Pathophysiology - As people age, the anatomy and physiology of their noses change. - This can include being unable to clear mucous (due to reduced secretion or impairment of the mucociliary escalator), atrophy of the mucosa or having reduced blood supply/ nasal vasculature to name a few. - These changes make the epithelial basement membrane of the nasal cells more permeable, causing dysregulation of normal osmosis oedema, then leading to subsequent chronic inflammation of the nasal mucosa. - This localised inflammation then causes the cell and tissues to undergo hyperplastic change, forming polyps. - The polyps then cause obstruction of airflow through the nose and block mucus drainage, allowing pathogens to linger in the nose and potentially cause infection and further inflammation. - This mucous blockage may also cause swelling of the mucosa, leading to further airway obstruction ### Clinical Features The clinical features of nasal polyps mainly relate to blockage of air flow and mucous drainage and can include: - Fever (due to blocked mucous leading to infection) - Headaches (due to blocked mucous building pressure in sinuses) - Rhinorrhea (runny nose due to blocked mucous) - Decreased Sense of Smell (due to airflow obstruction) - Snoring and Sleep Apnoea (due to airflow obstruction) - Samter's Triad ([[Asthma]], Nasal Polyps and Aspirin Hypersensitivity, see [[Aspirin]] for further details) ### Diagnosis - Formal diagnosis is typically made by a specialist through the use of nasal endoscopy or CT scan, typically after patient's first start experiencing symptoms. ### Management Although management is usually done by a specialist, the main forms of treatment will be to: - Intranasal corticosteroids to try and shrink the polyps - Endoscopic Sinus Surgery to remove the polyps (although they may return and need to be removed again in future) - Treat Underlying Condition (e.g. make sure asthma, allergies, infection is well managed etc.) ### Resources https://www.youtube.com/watch?v=6ebnqWV9KUk&t=244s&ab_channel=OsmosisfromElsevier https://www.ncbi.nlm.nih.gov/books/NBK560746/