Patient will present as → a 6-year old female who is being seen for a routine well-child exam is noted to have multiple teardrop-shaped growths partially obstructing the nasal passages. The child has a history of chronic sinusitis and recurring ear infections. As an astute PA, you order a sweat chloride test.
Nasal polyps (NP) are noncancerous growths within the nose or sinuses that appear as pale, boggy masses on the nasal mucosa
- Symptoms include trouble breathing through the nose, loss of smell, decreased taste, postnasal drip, and a runny nose
- Allergic rhinitis, acute and chronic infections, and cystic fibrosis all predispose to the formation of nasal polyps
- Finding nasal polyposis in a child is a “red flag” condition and should make the clinician suspicious of possible cystic fibrosis
- Samter's Triad is a chronic condition defined by asthma, sinus inflammation with recurring nasal polyps, and aspirin sensitivity
- It's also called aspirin-exacerbated respiratory disease (AERD), or ASA triad
A 3-month course of topical nasal corticosteroid is the initial treatment choice. This is effective for small polyps and can reduce the need for surgical intervention
- Oral steroids (6-day taper) can also help reduce the size
- Surgical removal may be necessary if therapy is unsuccessful or if polyps are large
perennial allergic rhinitis
Meconium ileus, intestinal obstruction secondary to inspissated meconium, occurs in approximately 10% of newborns with cystic fibrosis.
Nasal infections may occur secondary to a furuncle (infected hair follicle) in the anterior nares or as a nasal septal abscess following spread of a furuncle. Common causes of nasal infections include picking at the nose and pulling out nose hair.
Nasal polyps are uncommon in children younger than age 10, and when they do occur it is usually in older children and adults with allergic rhinitis.