Fast Five Quiz: Nasal Polyps Presentation and Diagnosis

Arlen D. Meyers, MD, MBA; Flavia Cecilia Lega Hoyte, MD

Disclosures

February 17, 2022

CT of the sinuses without contrast is the preferred imaging study for the diagnosis of nasal polyps. Coronal CT with ≤ 1-mm cuts and appropriate soft tissue and bone windows should be specified. Scan results should be reviewed with attention to structures such as the osteomeatal complex, the anterior ethmoid artery, orbital and skull base, the optic nerve, cavernous sinus, posterior sphenoethmoidal air (Onodi) cells, and each of the different sinuses.

Biopsy is not always required for the diagnosis of nasal polyps. However, nasal masses without the classic appearance of bilateral nasal polyps such as unilateral masses or those that do not respond to conservative treatment should be examined with careful biopsy for diagnosis.

Although many patients with nasal polyps do not need laboratory studies, they may benefit from nasal cell count, fungal/bacterial cultures from an endoscopic sample, or allergy and asthma studies, if indicated. With the new biologic agents approved for chronic rhinosinusitis with nasal polyps, phenotyping patients using biomarkers such as circulating eosinophil counts or assessments of atopy can be helpful in choosing a biologic agent, when necessary. In addition, children with nasal polyps should have an evaluation performed to rule out cystic fibrosis.

Learn more about the workup for nasal polyps.

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