Nasal polyps: Still more questions than answers

Abstract

Nasal polyps are common, affecting one to four per cent of the population. Their cause, however, remains unknown and it is possible that it is not the same in all patients. They have a clear association with asthma, aspirin sensitivity and cystic fibrosis. Histologically they demonstrate large quantities of extracellular fluid, mast cell degranulation and an infiltrate of inflammatory cells, usually eosinophils. While this appearance would suggest an allergic pathology there is little conclusive evidence to support this in most patients. There is, however, some preliminary evidence to suggest that a local allergic process could be the cause. While allergic fungal sinusitis is a well defined clinical entity with recognized diagnostic criteria the ubiquitous nature of fungal spores makes the role of fungal infection in patients with nasal polyps difficult to determine and currently this remains unclear. Surgical treatment of nasal polyps has declined in recent years as the benefits of medical treatment have become increasingly recognized. There is good evidence to support the use of corticosteroids both as a primary and post-operative treatment in the majority of patients. Other medical treatments require further evaluation before they could be considered a viable alternative to steroids. Assessment of the literature regarding surgical intervention is difficult and there is little evidence on which to base a surgical treatment philosophy. The authors believe that an endoscopic approach using a microdebrider facilitates accurate removal of polyps with preservation of normal anatomy.

A clinicopathological study of masses of nasal cavity paranasal sinuses and nasopharynx

“…The incidence being 1-4% of population. 1 Neoplasms of the sinuses and nasal cavity account for 0.2-0.8% of all carcinomas. 2 Prevalence rate of nasal polyp is about 2%.…”

Detection of Helicobacter pylori in Nasal Polyps

“…Nasal polyps are overgrowths of chronically inflamed nasal and paranasal sinus mucosa affecting about 1-4 % of the general population [1,2]. It is a multifactorial disease rather than a single disease entity.…”

Fungus culture and PCR in nasal lavage samples of patients with chronic rhinosinusitis

“…It is unclear whether nasal polyps are a distinct form of chronic sinusitis of unknown aetiology or whether they reflect an advanced stage of chronic sinusitis in general (Pawankar, 2003). Frequently, nasal polyps are associated with asthma or aspirin sensitivity (Bateman et al, 2003). Eosinophils are abundantly found in the tissue of most nasal polyps (Pawankar, 2003) and also within the mucus blanket covering the nasal and paranasal mucosa (Ponikau et al, 1999).…”