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 appear as pale, boggy masses on the nasal mucosa.
- 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.
- Often causes symptoms of blockage, discharge, or loss of smell.
- Samter's triad: Asthma, Aspirin sensitivity and nasal polyps.
Diagnosis is clinical
- Patients may complain of chronic congestion and a decreased sense of smell.
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 size.
- Surgical removal may be necessary if therapy is unsuccessful or if polyps are large.
Question 1 |
chronic rhinorrhea | |
nasal polyps | |
choanal atresia | |
perennial allergic rhinitis | |
acute sinusitis |
Question 2 |
choanal atresia | |
meconium ileus Hint: Meconium ileus, intestinal obstruction secondary to inspissated meconium, occurs in approximately 10% of newborns with cystic fibrosis. | |
nasal infection Hint: 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 Hint: 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. |
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