Incidence:
Whereas antrochoanal polyps represent only 4–6% of all nasal polyps in the general population, they represent about 33% of polyps in the pediatric population.
Etiology:
Cystic fibrosis is the most common childhood cause of nasal polyposis and should be suspected in any child <12 yr old with nasal polyps, even in the absence of typical respiratory and digestive symptoms; as many as 30% of children with cystic fibrosis acquire nasal polyps.
Nasal polyposis is also associated with chronic sinusitis and allergic rhinitis.
In the uncommon Samter triad, nasal polyps are associated with aspirin sensitivity and asthma.
Clinical Manifestations:
Obstruction of nasal passages is prominent, with associated hyponasal speech and mouth breathing. Profuse unilateral mucoid or mucopurulent rhinorrhea may also be present. An examination of the nasal passages shows glistening, gray, grapelike masses squeezed between the nasal turbinates and the septum.
Diagnosis:Examination of the external nose and rhinoscopy is performed. Ethmoidal polyps can be readily distinguished from the well-vascularized turbinate tissue, which is pink or red; antrochoanal polyps may have a more fleshy appearance. Antrochoanal polyps may prolapse into the nasopharynx; flexible nasopharyngoscopy can assist in making this diagnosis.
CT scan of the midface is key to diagnosis and planning for surgical treatment.
Treatment:Local or systemic decongestants are not usually effective in shrinking the polyps, although they may provide symptomatic relief from the associated mucosal edema. Intranasal steroid sprays, and sometimes systemic steroids, may provide some shrinkage of nasal polyps with symptomatic relief and have proved useful in children with cystic fibrosis and adults with nasal polyps.
Polyps should be removed surgically if complete obstruction, uncontrolled rhinorrhea, or deformity of the nose appears.
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