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
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. |
List |
References: Merck Manual · UpToDate