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Epidemiology & Risk Factors
- Chronic rhinosinusitis (most common association).
- Aspirin-Exacerbated Respiratory Disease (AERD / Samter Triad): Asthma + Aspirin/NSAID sensitivity + Nasal polyps.
- Cystic Fibrosis (CF): Must rule out CF in any pediatric patient presenting with nasal polyps. c
- Allergic fungal sinusitis.
- Kartagener syndrome (primary ciliary dyskinesia).
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Clinical Features
- Symptoms: Bilateral nasal obstruction, hyposmia/anosmia, congestion, rhinorrhea, post-nasal drip.
- PE: Smooth, teardrop-shaped, pale/pearly-gray, translucent, boggy masses.
- Key distinction: Polyps are nontender and do not bleed easily (unlike turbinates).
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Diagnosis
- Initial: Anterior rhinoscopy or flexible nasal endoscopy (direct visualization of mobile, insensitive, pale masses).
- Imaging: CT scan of sinuses (coronal view) to assess extent prior to surgery. Shows opacification of sinuses and polypoid masses.
- Workup for associated conditions:
- Sweat chloride test in pediatric patients (to rule out CF). c
- Biopsy: Indicated for unilateral polyps to rule out malignancy or inverted papilloma.
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Management
- First-line: Intranasal corticosteroids (e.g., fluticasone, budesonide) to reduce size and improve symptoms.
- Second-line: Short-course oral corticosteroids (prednisone) for severe obstruction or refractory symptoms.
- Medical Add-ons: Leukotriene receptor antagonists (montelukast) especially if AERD present. Biologics (e.g., Dupilumab [anti-IL-4Ra]) for refractory chronic rhinosinusitis with nasal polyps.
- Refractory: Functional Endoscopic Sinus Surgery (FESS) with polypectomy. Note: High recurrence rate post-surgery; maintenance intranasal steroids required.
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Complications
- Obstructive Sleep Apnea (OSA) due to nasal airway obstruction.
- Chronic/recurrent bacterial rhinosinusitis (due to sinus drainage obstruction).
- Anosmia/ageusia (often permanent if long-standing).
- Bony erosion/remodeling of nasal septum or sinuses (rare, seen in massive, neglected cases).