Nasal polyps are soft, painless growths of inflamed lining in the nose and sinuses, usually part of chronic rhinosinusitis. They are linked with asthma and aspirin sensitivity, and a polyp on one side needs a check for a tumor.
Key symptoms
- Blocked nose on both sides
- Reduced or lost sense of smell
- Runny nose or postnasal drip
- Facial pressure lasting 12 weeks or more
What you find on exam
- Pale, grape-like masses that are not tender on anterior rhinoscopy
- Usually on both sides; one side raises concern
- Ask about asthma and reactions to aspirin or NSAIDs
- Listen for wheeze
Tests
- Nasal endoscopy by ENT
- CT of the sinuses if surgery is planned or the diagnosis is unclear
- Biopsy of a one-sided polyp
- Sweat chloride test in a child with polyps (cystic fibrosis)
Treatment basics
- Daily steroid nasal spray such as fluticasone
- Saline rinses
- Short course of oral prednisone for severe blockage
- Endoscopic sinus surgery if medical treatment fails
- Biologics such as dupilumab for severe recurrent disease
Red flags
- One-sided polyp, bleeding or pain (possible tumor)
- Eye swelling, double vision or vision change
- Severe headache or confusion
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.