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A 35-year-old man complains of unilateral nasal obstruction for the past several months of gradual onset. On examination of the nose, a nasal polyp is found (Figure 32-1).
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Nasal polyps are benign lesions arising from the mucosa of the nasal passages, including the paranasal sinuses. They are most commonly semitransparent.
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Prevalence of 1% to 4% of adults; 0.1% of children of all races and classes1.
The male-to-female ratio in adults is approximately 2-4:1.
Peak age of onset is 20 to 40 years; rare in children younger than 10 years.
Associated with the following conditions:
Nonallergic and allergic rhinitis and rhinosinusitis
Asthma—In 20% to 50% of patients with polyps
Cystic fibrosis
Aspirin intolerance—In 8% to 26% of patients with polyps
Alcohol intolerance—In 50% of patients with polyps
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ETIOLOGY AND PATHOPHYSIOLOGY
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The precise cause of nasal polyp formation is unknown.
Infectious agents causing desquamation of the mucous membrane may play a triggering role.
Activated epithelial cells appear to be the major source of mediators that induce an influx of inflammatory cells, including eosinophils prominently; these in turn lead to proliferation and activation of fibroblasts.2 Cytokines and growth factors play a role in maintaining the mucosal inflammation associated with polyps.
Food allergies are strongly associated with nasal polyps.
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The appearance is usually smooth and rounded (Figure 32-1).
Moist and translucent (Figure 32-2).
Variable size.
Color ranging from nearly none to deep erythema.
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LABORATORY AND IMAGING
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Consider allergy testing.
In children with multiple polyps, order sweat test to rule out cystic fibrosis.
CT of the nose and paranasal sinuses may be indicated to evaluate extent of lesion(s) (Figure 32-3).
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