Nasal Polyposis

Clinical Spectrum and Treatment Approaches
  • Guy A. Settipane
  • Russell A. Settipane

Abstract

Nasal polyps and high recurrence rate in patients after treatment have always been an enigma. Despite many new drugs and various surgical procedures, the recurrence rate is unacceptably high. Various factors appear to be related to nasal polyps and their high recurrence rate. These factors include age of onset, asthma, aspirin intolerance, bacterial sinusitis, fungal sinusitis, other disease states, acute upper respiratory infections, and allergens. The classical tetrad syndrome associated with nasal polyps is aspirin intolerance, asthma, chronic sinusitis, and nasal polyps. Part of this tetrad was first described by Widal et al. in 1922 (1, 2). They described the triad of nasal polyps, asthma, and aspirin intolerance, but not chronic sinusitis. Frequently, polyps are associated with chronic sinusitis for three main reasons. First, polyps may disrupt or entirely block the ostiomeatal complex, leading to chronic sinusitis on a mechanical basis. Second, the eosinophilia associated with most polyps is toxic to the ciliated membranes producing a decrease in flow of mucus, and this stasis could result in sinusitis (3). This mechanism is thought to be through the toxic effect of the major basic protein associated with eosinophilia. Finally, polyps can occur within the paranasal sinus causing a mechanical and toxic obstruction (eosinophilia) from within the sinus. Also, pressure on the intrasinus membranes and bone can actually cause destruction of bone, Woakes disease (4), or midfacial expansion. Facial deformation occurring with juvenile nasal polyposis is well described (frog face). The tetrad of nasal polyps, asthma, aspirin intolerance, and rhinosinusitis is a more realistic grouping of this pattern of classic symptoms.

Keywords

Corticosteroid Mold Serotonin Norepinephrine Sponge 

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References

  1. 1.
    Widal MF, Abram P, Lermoyez J. Anaphylaxie et idiosyndraise. Presse Med 1922;22:191.Google Scholar
  2. 2.
    Settipane GA. Landmark commentary: history of aspirin intolerance. Allergy Proc 1990; 11:251,252.CrossRefGoogle Scholar
  3. 3.
    Davidson AE, Miller DS, Settipane RJ, Ricci AR, Klein DE, Settipane GA. Delayed nasal mucociliary clearance in patients with nonallergic rhinitis and nasal eosinophilia. Allergy Proc 1991;12(no. 6):402.Google Scholar
  4. 4.
    Wentges RTR. Edward Woakes: the history of an eponym. J Laryngol Otol 1972;86:501–512.PubMedCrossRefGoogle Scholar
  5. 5.
    Atzelius BA. Disorders of ciliary motility. Hosp Pract 1986;21:73–80.Google Scholar
  6. 6.
    Rossman CM, Lee RM, Forrest JB, Newhouse MT. Nasal canary ultrastructure and function in patients with primaryciliary dyskinesia compared with that in normal subjects and in subjects with various respiratory diseases. Am Rev Respir Dis 1984; 129:161–167.PubMedGoogle Scholar
  7. 7.
    Schanker HM, Rajfer J, Saxon A. Recurrent respiratory disease, azoospermia, and nasal polyposis. Arch Intern Med 1985;145:2201–2203.PubMedCrossRefGoogle Scholar
  8. 8.
    Handelsman DJ, Conway AJ, Boylan LM, Turtle JR. Young’s syndrome. Obstructive azoospermia and chronic sinopulmonary infections. N Engl J Med 1984;310:3–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Schwietz LA, Gourley DS. Allergic fungal sinusitis. Allergy Proc 1992;13:3–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Vancil ME. A historical survey of treatments for nasal polyposis. Laryngoscope 1969;79:435–445.PubMedCrossRefGoogle Scholar
  11. 11.
    Settipane GA, Chafee FH. Nasal polyps in asthma and rhinitis: a review of 6,037 patients. J Allergy Clin Immunol 1977;59:17–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Chafee FH, Settipane GA. Aspirin intolerance: I. Frequency in an allergic population. J Allergy Clin Immunol 1974;53:193–199.CrossRefGoogle Scholar
  13. 13.
    Settipane GA, Chafee FH, Klein DE. Aspirin Intolerance: II. A prospective study in an atopic and normal population. J Allergy Clin Immunol 1974;53:200–204.PubMedCrossRefGoogle Scholar
  14. 14.
    Slavin RG, Linford P, Friedman WH. Sinusitis and bronchial asthma. J Allergy Clin Immunol 1982;69(part2): 102.CrossRefGoogle Scholar
  15. 15.
    Lanoff G, Daddono A, Johnson E. Nasal polyps in children:a ten-year study. Ann Allergy 1973;31:551–554.PubMedGoogle Scholar
  16. 16.
    Settipane GA, ed. In: Rhinitis, 2nd ed., Providence: Oceanside Publications, 1992; pp. 175,176.Google Scholar
  17. 17.
    Ballantyne J. The nose. In: Grooves J, ed. Scott Brown’s Diseases of the Ear, Nose and Throat, 3rd ed. Philadelphia: JB Lippincott, 1971; p. 179.Google Scholar
  18. 18.
    Oppenheimer EH, Rosenstein BJ. Differential pathology of nasal polyps in cystic fibrosis and atopy. Lab Invest 1979;40:445–449.PubMedGoogle Scholar
  19. 19.
    Wladislavosky-Wasserman P, Kern EB, Holley KE, Gleich GJ. Epithelial damage is commonly seen in nasal polyps. J Allergy Clan Immunol 1982;69(part 2): 148.CrossRefGoogle Scholar
  20. 20.
    Busuttil A. Dysplastic epithelial changes in nasal polyps. Ann Otol Rhinol Laryngol 1978;87:416–420.PubMedGoogle Scholar
  21. 21.
    Settipane GA, ed. Rhinitis, 1st ed., Providence: NER Allergy Proc, 1984; p. 152.Google Scholar
  22. 22.
    MacKay DN. Antibiotic treatment of rhinitis and sinusitis. Am J Rhinol 1987; 1:83–85.CrossRefGoogle Scholar
  23. 23.
    Pelletier G, Hebert J, Bedard PM, Salari H, Borgeat P. Profile of leukotrienes and histamine from human nasal polyps. J Allergy Clin Immunol 1986;77(part 2): 177 (abstract).Google Scholar
  24. 24.
    Bumsted RM, El-Ackad T, Smith JM, Brody MJ. Histamine, norepinephrine and serotonin content of nasal polyps. Laryngoscope 1979;89:832–843.PubMedCrossRefGoogle Scholar
  25. 25.
    Kaliner M, Wasserman SI, Austen KF. Immunologic release of chemical mediators from human nasal polyps. N Engl J Med 1973;289:277–281.PubMedCrossRefGoogle Scholar
  26. 26.
    Chandra RK, Abrol BM. Immunopathology of nasal polypi. J Laryngol Otol 1974;88:1019–1024.PubMedCrossRefGoogle Scholar
  27. 27.
    Berdal P. Serologic investigations on the edema fluid from nasal polyps. J Allergy 1952;23:11–14.PubMedCrossRefGoogle Scholar
  28. 28.
    Mygind N, ed. Nasal polyps. In: Nasal Allergy, 2nd ed., Oxford, London: Blackwell Scientific, 1979; pp. 233–238.Google Scholar
  29. 29.
    Gray L. Deviated nasal septum. III. Its influence on the physiology and disease of the nose and ear. J Laryngol 1967;81:953–986.CrossRefGoogle Scholar
  30. 30.
    Tos M, Mogensen C. Density of mucous glands in normal adult nasal septum. Arch Otorhinolaryngol 1977; 215:101.PubMedCrossRefGoogle Scholar
  31. 31.
    Bernstein JM, Cropp JA, Nathanson I, Yankaskas JR. Bioelectric properties of cultured human nasal polypi and turbinate epithelial cells. Am J Rhinol 1990;4(no. 2):45–49.CrossRefGoogle Scholar
  32. 31a.
    Tos M. The pathogenetic theories on formation of nasal polyps. Am J Rhinol 1990;4:51–56.CrossRefGoogle Scholar
  33. 32.
    Downing ET, Braman S, Settipane GA. Bronchial reactivity in patients with nasal polyps before and after polypectomy. J Allergy Clin Immunol 1982;69(part 2):102.CrossRefGoogle Scholar
  34. 33.
    Miles-Lawrence R, Kaplan M, Chang K. Methacholine sensitivity in nasal polyposis and the effects of polypectomy. J Allergy Clin Immunol 1982;69 (part 2): 102.CrossRefGoogle Scholar
  35. 34.
    Connell JT. Nasal disease. N Engl Soc Allergy Proc 1982;3:389–396.CrossRefGoogle Scholar
  36. 35.
    Settipane GA. Aspirin intolerance presenting as chronic rhinitis. R I Med J 1980;63:63–65.PubMedGoogle Scholar
  37. 36.
    Whiteside TL, Rabin BS, Zetterberg J, Criep L. The presence of IgE on the surface of lymphocytes in nasal polyps. J Allergy Clin Immunol 1975;55:186–194.PubMedCrossRefGoogle Scholar
  38. 37.
    Settipane GA, Klein DE, Lekas MD. Asthma and nasal polyps. In: Myers E, ed., New Dimensions in Otorhinolaryngology, Head and Neck Surgery. Amsterdam: Excerpta Medica, 1987; pp. 499,500.Google Scholar
  39. 38.
    Settipane GA, Pudupakkam RK. Aspirin intolerance. III. Subtypes, familial occurrence and cross-reactivity with tartrazine. J Allergy Clin Immunol 1975;56: 215–221.PubMedCrossRefGoogle Scholar
  40. 39.
    Simon R, Pleskow W, Kaliner M, Wasserman S. Plasma mediator studies in aspirin sensitive asthma. J Allergy Clin Immunol 1983;71(part 2):146(abstract).CrossRefGoogle Scholar
  41. 40.
    Settipane GA. Nasal polyposis. N Engl Soc Allergy Proc 1982;3:497–504.CrossRefGoogle Scholar
  42. 41.
    McCleve D, Gatos L, Goldstein J, Slivers S. Corticosteroid injections of the nasal turbinates: past experience and precautions. ORL J Otorhinolaryngol Related Specialties 1978;86:851–857.Google Scholar
  43. 42.
    Mabry RL. Visual loss after intranasal corticosteroid injection. Arch Otolaryngol 1981; 107:484–486.PubMedCrossRefGoogle Scholar
  44. 43.
    Settipane GA. Nasal polyps: epidemiology, pathology, immunology and treatment. Am JRhinol 1987; 1:119–126.CrossRefGoogle Scholar
  45. 44.
    Settipane GA, Klein DE, Settipane RJ. Nasal polyps, state of the art. Rhinology 1991; 11:33–36.Google Scholar
  46. 45.
    Norlander T, Fukami M, Westrin KM, Stierna P, Carlsog B. Formation of mucosal polyps in the nasal and maxillary sinus cavities by infection. Otolaryngol H, S Surg. 1993; 109:522–529.Google Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Guy A. Settipane
  • Russell A. Settipane

There are no affiliations available

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