A 14-year-old boy complains of unilateral nasal obstruction for the past several months of gradual onset. On examination of the nose, a nasal polyp is found (Figure 25-1).

Nasal polyps are benign lesions arising from the mucosa of the nasal passages including the paranasal sinuses. They are most commonly semitransparent and pale in appearance.

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  Prevalence of 0.1 percent of children of all races and classes.

  
  
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  Nasal polyps are rare in children younger than 10 years old; peak age of onset is age 20 to 40 years.

  
  
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  Associated with the following conditions:

  
  
  
  
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    Nonallergic and allergic rhinitis and rhinosinusitis.

    
    
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    Asthma—In 20 percent to 50 percent of patients with polyps.

    
    
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    Cystic fibrosis.

    
    
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    Aspirin intolerance—In 8 percent to 26 percent of patients with polyps.

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  Nasal polyposis is an inflammatory process. The precise cause is unknown, but genetic associations have been identified.²

  
  
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  Infectious agents causing desquamation of the mucous membrane can play a triggering role. Presence of Helicobacter pylori was identified in nasal flora in all 25 patients in one case series.³

  
  
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  Activated epithelial cells appear to be the major source of mediators that induce an influx of inflammatory cells, including eosinophils prominently; these in turn lead to proliferation and activation of fibroblasts.⁴ Cytokines and growth factors play a role in maintaining the mucosal inflammation associated with polyps.

  
  
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  Food allergies including milk allergy are strongly associated with nasal polyps.

Clinical Features

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  The appearance is usually smooth and rounded (Figure 25-1).

  
  
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  Moist and translucent (Figure 25-2).

  
  
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  Variable size.

  
  
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  Color ranging from nearly none to deep erythema.