History and exam

Key diagnostic factors

common

nasal obstruction

Occurs in 92% of patients with chronic rhinosinusitis.[2]​​

Most often obstruction is bilateral in patients with nasal polyps. Nasal obstruction may be valvular, with obstruction in either inspiration or expiration, depending on the size and location of the polyps.

Unilateral obstruction should be regarded as suspicious of a neoplasm until shown otherwise.[25][26]

nasal discharge

Anterior and/or posterior nasal drips are common in patients with nasal polyps.[2] If there is an associated infection, discharge may be mucopurulent. Bloodstained nasal discharge should arouse suspicion for a nasal tumor.[26]

polyps visible on examination or imaging

Nasal polyps must be seen on anterior rhinoscopy or nasendoscopy, or indirectly on CT scan, for the diagnosis to be made.[2]

Other diagnostic factors

common

facial pain/pressure

Facial congestion-pressure-fullness occurs in 67% of patients with chronic rhinosinusitis.[2]

However, facial pain/pressure and nasal polyps are poorly correlated; facial pain/pressure is more common in patients with chronic rhinosinusitis without nasal polyps.

reduced sense of smell/anosmia

This occurs in 84% of patients with chronic rhinosinusitis.[2]

cough

Occurs secondary to tracheal and laryngeal irritation caused by postnasal drip, or as a result of associated asthma.

Risk factors

strong

asthma

Asthma is reported in 20% to 60% of patients with chronic rhinosinusitis with nasal polyps (CRSwNP).[3][6]​ Approximately 7% of people with asthma have CRSwNP; this figure is raised to 15% to 26% in those with adult-onset, eosinophilic asthma.[3]

eosinophilic granulomatous polyangiitis (EGPA, also known as Churg-Strauss syndrome)

This syndrome involves a combination of severe asthma, chronic rhinosinusitis (typically with nasal polyposis), eosinophilia, and eosinophilic vasculitis with granulomas.[23]​ Other features can include mononeuritis and cardiomyopathy. 

allergic fungal rhinosinusitis (AFRS)

AFRS typically presents with nasal polyps and sinus opacification, which may be asymmetric and lead to sinus expansion and local tissue erosion. Allergic fungal rhinosinusitis is rare in the UK, but is more common in warm, humid climates such as the southern and southeastern US, India, and the Middle East.[24]​​

aspirin sensitivity

People with aspirin- and nonsteroidal anti-inflammatory drug-exacerbated respiratory disease have a higher incidence of nasal polyps (estimates range from 7% to 26%).[3]

weak

genetic predisposition

Genetic associations have been reported in some cases, but the evidence is limited.[8][9][10]​​​​​​ Population studies have demonstrated a four- to fivefold increased risk of CRSwNP in people who have a first-degree relative with CRSwNP.[10][11]​​​ Specific risk genes are not yet well characterized.[12]

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