Nasal polyps occur when the mucous membrane lining the inside of the nose becomes inflamed and swollen and distends into the nasal cavity, creating noncancerous, semitranslucent, round, bag-like protuberances.
The polyps look like small, pearly grapes and can appear as a single polyp or in clusters. Although harmless, they often obstruct the nasal passages and are often accompanied by nasal discharge. They may also cause facial pain and interfere with the sense of smell.
Polyps are often associated with asthma, allergic rhinitis (hay fever), vasomotor rhinitis (which may be caused by changes in the temperature or humidity, scents in the air, smoke, cooking odors, or emotional stress), certain kinds of drug use, chronic sinus infections, and cystic fibrosis.Incidence and Prevalence: Estimates of the prevalence of nasal polyps vary considerably from study to study. Rates range from 0.2% to 4% of the general population (Pearlman). About 40% of individuals with cystic fibrosis have nasal polyps (Weber), as do up to 50% of individuals with aspirin sensitivity (Pearlman). |
Source: Medical Disability Advisor
| Individuals with aspirin hypersensitivity are at higher risk of developing nasal polyps. Individuals between the ages of 40 and 60 are at highest risk. There is a strong association between asthma and nasal polyps. Children with nasal polyps should be examined for cystic fibrosis (Pearlman). |
Source: Medical Disability Advisor
History: Symptoms may include nasal blockage, stuffed nose, postnasal drip, and decreased or absent sense of smell. Some individuals may have a clear nasal discharge and sneezing. Some individuals may complain of sinus pressure and headaches. Physical exam: Nasal examination (nasal endoscopy) with an instrument that enlarges the opening of the nose for inspection (nasal speculum) reveals a grayish grape-like mass within the nasal cavity. Shining a light up the nostrils while using a mirror to view the inside of the nose may reveal the polyps, although most polyps are not easily seen. Tests: A nasal smear may show an increase in eosinophils, a type of white blood cell. A culture for fungal or bacterial infection may also be done. In cases where medical treatment is ineffective, and surgery is an option, a computed tomography (CT) scan is often done. Allergy testing is considered controversial because the results may not significantly influence the plan of treatment. Because nasal polyps may be part of a systemic disease such as cystic fibrosis or asthma, other tests may be done to determine the underlying condition. |
Source: Medical Disability Advisor
Medical treatment with a nasal steroid spray or a short course of oral corticosteroids is usually effective and causes the polyps to shrink or disappear. Because the polyps may recur, there may be a need for long-term nasal steroid use. Otherwise, treatment with oral corticosteroids may need to be repeated intermittently. Surgery to remove the polyps (polypectomy) and any infected tissue is recommended if nonsurgical treatment is unsuccessful.
Surgery for nasal polyps is usually done on an outpatient basis with the use of a local anesthetic. Surgery is sometimes followed by treatment with a steroid nasal spray. |
Source: Medical Disability Advisor
| Treatment can be effective in relieving signs and symptoms. Surgical removal usually allows easier breathing through the nose and improves sinus drainage and the sense of smell. The predicted outcome depends largely on the amount and size of nasal polyps that are present. Nasal polyps may recur. |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
- Allergist/Immunologist
- Otolaryngologist
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Source: Medical Disability Advisor
Source: Medical Disability Advisor
| Individuals with nasal polyps may lose their sense of smell and are predisposed to obstructive sleep apnea. Nasal polyps may recur after treatment. Chronic sinus infection can also result from nasal polyps, in which case the possible complications include asthma exacerbations, spread of infection to the eye or the meninges, and formation of aneurysms or blood clots in the veins around the sinuses. |
Source: Medical Disability Advisor
| No disability is caused by nasal polyps alone. The treatment approach and the individual's response to treatment may influence duration of symptoms. |
Source: Medical Disability Advisor
| Individuals may need to avoid dust, chemicals, allergens, or strong odors that might irritate or stimulate growth of the polyps. Risk: Individuals who do not respond to front line treatment and who undergo allergy testing and are found to be allergic to exposures in the workplace may be at increased risk for persistent symptoms. Capacity: There should be no impact on capacity in individuals with nasal polyps that are well controlled. Capacity may be reduced if the work environment continues to expose a susceptible individual. Tolerance: Tolerance is dependent on capacity, which is usually unlimited. Susceptible individuals may benefit from nasal corticosteroid sprays to permit greater tolerance in the work environment. |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have any risk factors for nasal polyps? What is age of individual? Is individual hypersensitive to aspirin?
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Does individual have asthma? Cystic fibrosis?
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Does individual exhibit nasal blockage, stuffed nose, postnasal drip, and decreased or absent sense of smell? Clear nasal discharge and sneezing?
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Does individual complain of sinus pressure and headaches?
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Was nasal endoscopy performed? Were polyps seen? How many?
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Was nasal smear obtained? Fungal or bacterial culture?
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Was allergy testing done?
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Was CT scan necessary?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Did individual respond to conservative treatment of nasal steroid spray or a short course of oral corticosteroids?
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Was polypectomy necessary? Removal of infected tissue?
Regarding prognosis:
- Is individual compliant with recommended medications?
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Is individual's employer able to accommodate avoidance of dust, chemicals, allergens, or strong odors that might aggravate the polyps?
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Does individual follow the restrictions away from work as well?
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Does individual have allergies, seasonal hay fever, aspirin sensitivity, or a diagnosis of cancer in the nasal cavity?
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Did individual lose his or her sense of smell?
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Did individual develop obstructive sleep apnea?
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Does individual have chronic sinus infections? Spread of infection to the eye or the meninges? Asthma exacerbations?
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Have aneurysms or blood clots formed in the veins around the sinuses?
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Source: Medical Disability Advisor
| CitedMcClay, John E. "Nasal Polyps." eMedicine. Eds. Glenn C. Isaacson, et al. 1 May. 2014. Medscape. 5 Oct. 2014 <http://emedicine.medscape.com/article/994274-overview>.Pearlman, Aaron N., et al. "Epidemiology of Nasal Polyps: Pathogenesis, Medical and Surgical Treatment,." Nasal Polyposis. Eds. T. Metin Onerci and Berrylin J. Ferguson. Springer, 2010. 9-15. Weber, S. A., and G. F. Ferrari. "Incidence and Evolution of Nasal Polyps in Children and Adolescents with Cystic Fibrosis." Brazilian Journal of Otorhinolaryngology 74 (2008): 16-20. |
Source: Medical Disability Advisor