Nasal Polyposis

Nasal polyps are most frequently found in patients with aspirin intolerance and intrinsic asthma, especially in those over 40 years of age. Children 16 years or younger with nasal polyps should be evaluated for cystic fibrosis. Nasal polyps are frequently bilateral, multiple, freely movable, pale-gray, and arise from the middle-meatus of the nose. Histologically, they have ciliated columnar epithelium, thickening of the epithelial basement membrane, high stromal eosinophile count, mucin with neutral pH, few glands, and essentially no nerve endings. Cells consist of a mixture of lymphocytes, plasma cells, and eosinophils. Chemical mediators found in nasal polyps are histamine, serotonin, SRS-A, ECF-A, and Norepinephrine. There is more histamine in nasal polyps than in normal nasal mucosa, and norepinephrine is present in greater concentration in the base of nasal polyps than in normal mucosa. The concentration of IgA and IgE and, in some cases, IgG and IgM are greater in polyp fluid than in serum. IgE mediated disease is not the cause of nasal polyps, but when present, may contribute to episodes of exacerbation. Despite medical or surgical management, a significant number of nasal polyps are recurrent. For treatment systemic corticosteroids should be tried before polypectomy. Polypectomy does not increase the risk of developing asthma or making asthma worse. At the present time, the pathogenesis of polyp formation is unknown.