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Nasal Polyposis

Clinical Spectrum and Treatment Approaches

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Diseases of the Sinuses

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Abstract

Nasal polyps and high recurrence rate in patients after treatment have always been an enigma. Despite many new drugs and various surgical procedures, the recurrence rate is unacceptably high. Various factors appear to be related to nasal polyps and their high recurrence rate. These factors include age of onset, asthma, aspirin intolerance, bacterial sinusitis, fungal sinusitis, other disease states, acute upper respiratory infections, and allergens. The classical tetrad syndrome associated with nasal polyps is aspirin intolerance, asthma, chronic sinusitis, and nasal polyps. Part of this tetrad was first described by Widal et al. in 1922 (1, 2). They described the triad of nasal polyps, asthma, and aspirin intolerance, but not chronic sinusitis. Frequently, polyps are associated with chronic sinusitis for three main reasons. First, polyps may disrupt or entirely block the ostiomeatal complex, leading to chronic sinusitis on a mechanical basis. Second, the eosinophilia associated with most polyps is toxic to the ciliated membranes producing a decrease in flow of mucus, and this stasis could result in sinusitis (3). This mechanism is thought to be through the toxic effect of the major basic protein associated with eosinophilia. Finally, polyps can occur within the paranasal sinus causing a mechanical and toxic obstruction (eosinophilia) from within the sinus. Also, pressure on the intrasinus membranes and bone can actually cause destruction of bone, Woakes disease (4), or midfacial expansion. Facial deformation occurring with juvenile nasal polyposis is well described (frog face). The tetrad of nasal polyps, asthma, aspirin intolerance, and rhinosinusitis is a more realistic grouping of this pattern of classic symptoms.

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Authors
  1. Guy A. Settipane MD
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  2. Russell A. Settipane MD
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Editor information

Editors and Affiliations

  1. Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, CA

    M. Eric Gershwin MD  & Gary A. Incaudo MD  & 

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© 1996 Springer Science+Business Media New York

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Settipane, G.A., Settipane, R.A. (1996). Nasal Polyposis. In: Gershwin, M.E., Incaudo, G.A. (eds) Diseases of the Sinuses. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-0225-7_14

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  • DOI: https://doi.org/10.1007/978-1-4612-0225-7_14

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4612-6670-9

  • Online ISBN: 978-1-4612-0225-7

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