Nasal Polyposis
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
Clinical presentation is variable and depends on the extent of polyp disease. Small polyps may not produce symptoms and may be identified incidentally during rhinoscopic examination, whilst larger polyps may cause significant symptoms. In general, patients with nasal polyps will present with various symptoms that have generally persisted over months to years, progressing from mild nasal congestion with a watery rhinorrhoea to a persistent nasal obstruction associated with hyposmia or anosmia, as well as a thicker post nasal discharge and very occasionally headaches. Epistaxis is not associated with benign polyps and may suggest a more serious pathology in the nasal cavities. Massive polyps or a single large polyp that obstructs the nasal cavities or nasopharynx can cause chronic mouth breathing and obstructive sleep symptoms. Rarely, proptosis, hypertelorism and diplopia can result from alterations in the craniofacial structure. Generally, because of their slow-growing nature, massive polyposis does not cause neurological symptoms or pain, even if they extend into the intracranial cavity (Figure 95.1).
The nose and nasopharynx
Rogan J Corbridge in Essential ENT, 2011
A nasal polyp is simply a descriptive term for a pedunculated swelling arising in the nose or paranasal sinuses. Polyps may develop in both benign and malignant conditions. In this section, we deal with those simple inflammatory polyps that are most common. Other types of polyps that may herald malignant disease are discussed later in this chapter. Simple inflammatory polyps are usually bilateral, and therefore a unilateral polyp must be biopsied to exclude malignancy. Prolapse of the meninges (meningocoele) or brain tissue (encephalocoele) can occur through the roof of the nasal cavity and may mimic such a polyp; this must be excluded before biopsy.
The effect of intranasal corticosteroids on nasal polyps as assessed by expression of Tumour Necrosis Factor Alpha (TNF-α)
Cut Adeya Adella in Stem Cell Oncology, 2018
Nasal polyps are a manifestation of the inflammatory process, so corticosteroids are an effective therapy (Ferguson & Orlandi, 2006). Corticosteroids have extensive anti-inflammatory effects. Apoptosis is an important process in reducing the number of inflammatory cells. Corticosteroids induce the process of apoptosis of inflammatory cells in nasal polyps (Assanasen & Naclerio, 2001). Intranasal or systemic corticosteroids work by reducing the concentration of inflammatory mediators and inflammatory cells by inhibiting cell proliferation and inducing apoptosis (Jankowski et al., 2002).
Exosomes Represent an Immune Suppressive T Cell Checkpoint in Human Chronic Inflammatory Microenvironments
Published in Immunological Investigations, 2020
Gautam N Shenoy, Maulasri Bhatta, Jenni L Loyall, Raymond J Kelleher Jr, Joel M Bernstein, Richard B Bankert
Nasal polyps are benign growths resulting from a rapid proliferation of the upper airway epithelium and other associated cells in the lateral wall of the nose (Newton and Ah-See 2008; Ryan and Davis 2010). All of the cellular and molecular factors that are responsible for the development, progression and failure to resolve the polyps in humans have not yet been determined. The polyps arise from a persistent inflammation associated with microbial infections, asthma, rhinitis, and cystic fibrosis (Bernstein et al. 2006). The histopathology of nasal polyps includes the hyperplasia of the mucosal epithelium, infiltration of multiple different inflammatory cell types, mucin producing goblet cells and submucosal glands (Bernstein et al. 2009). Multiple inflammatory cells and many of the factors they produce have been identified and associated with the pathology observed in this condition (Bernstein et al. 2004; Ickrath et al. 2017; Sanchez-Segura et al. 1998). However, the mechanisms and complex interactions of the cells and subcellular components that contribute to nasal polyposis, and its failure to be resolved normally or by therapeutic intervention are largely unknown. To address these issues, we have chosen to investigate the interaction of immune cells with acellular factors present in the polyp microenvironment and to assess the consequences of this interaction with respect to cell function.
Safety review of current systemic treatments for severe chronic rhinosinusitis with nasal polyps and future directions
Published in Expert Opinion on Drug Safety, 2021
David Ranford, Claire Hopkins
Chronic Rhinosinusitis (CRS) is a common condition that is defined as inflammation of the lining of the nose and paranasal sinuses. The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 defines CRS in adults as the presence of at least two or more symptoms, one of which should be nasal blockage/obstruction/congestion or discharge, with or without facial pressure/pain and reduction/loss of sense of smell for longer than 12 weeks [1]. There should be evidence of polyps or mucopurulent discharge or mucosal obstruction on nasal endoscopy, or mucosal changes within the ostiomeatal complex or sinuses on computed tomography [1]. CRS can occur with (CRSwNP) or without nasal polyps (CRSsNP). Nasal polyps are grape-like swellings of the nasal lining of the nasal passage and sinuses. Despite some heterogeneity in the underlying etiology and pathophysiology underpinning CRS, the vast majority of nasal polyps are inflammatory, with 85% of polyps demonstrating a type 2 pattern of inflammation characterized by eosinophilia and elevated type 2 inflammatory cytokines, including interleukin-4 (IL-4) and IL-5 [2].
Relative frequencies of symptoms and risk factors among patients with chronic rhinosinusitis with nasal polyps using a case-control study
Published in Acta Oto-Laryngologica, 2018
Anton Bohman, Martin Oscarsson, Kenneth Holmberg, Leif Johansson, Eva Millqvist, Salmir Nasic, Mats Bende
In one study, symptoms were investigated in 165 patients with nasal polyps; polyps were more common among males (63%), and the most common symptoms were nasal blockage (88%), anosmia (78%) and rhinorrhoea (66%) [6]. In another study of 1784 patients with CRSwNP, the most common symptoms reported were nasal blockage (97%), altered sense of taste and/or smell (90%) and the need to blow one’s nose (80%) [16]. This study principally confirms these data and also the clinical experience of the disease. However, by comparing our data with the general population of the same district, it was also possible to calculate the OR for each symptom and test these symptoms in a multiple logistic regression model. Nasal secretion, nasal blockage and impaired sense of olfaction were symptoms significantly associated with CRSwNP in our multivariate analysis; sneezing and parosmia were significant in the univariate analysis but not in the multivariate, probably due to them being associated with other nasal symptoms and not the disease itself.