Skip to main content

Nasal Polyposis in Children: A Differential Diagnosis and Algorithm

  • Chapter
  • First Online:
Nasal Polyposis

Abstract

The aetiology of many paediatric nasal polyps is not known; however, it is vital to make a diagnosis in order to help patients wherever possible. The term “a nasal polyp” is not a diagnosis but a sign of inflammation of the lining of the nose that can be due to a range of significant diseases. The main differential diagnoses are an antrochoanal polyp, cystic fibrosis, primary ciliary dyskinesia, immunodeficiency, chronic infection, allergic aspergillosis, inverted papilloma, haemangioma, angiofibroma, encephalocoele, a nasal glioma or malignancy. Antrochoanal polyps result from mucosal retention cysts in the maxillary sinus that have prolapsed either through the infundibulum or accessory ostia. The best way of reducing the chance of them recurring is to remove the mucosa around their base so that scar tissue forms and they do not recur. The management of paediatric polyposis is often disappointing because apart from those with an antrochoanal polyp, the recurrence rate is high.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 189.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Afzelius BA (1976) A human syndrome caused by immotile cilia. Science 193:317–319

    Article  PubMed  CAS  Google Scholar 

  2. Andersen I, Lundqvist GR, Proctor DF (1971) Human nasal mucosal function in a controlled climate. Arch Environ Health 23:408–420

    PubMed  CAS  Google Scholar 

  3. Basu SK, Bandyopadhay SN, Bora H (2001) Bilateral antrochoanal polyps. J Laryngol Otol 115:561–562

    Article  PubMed  CAS  Google Scholar 

  4. Batsakis JG (ed) (1979) Tumours of the head and neck, 2nd edn. Williams and Watkins, Baltimore, MD, pp140–149

    Google Scholar 

  5. Berg O, Carenfelt C, Silfverswärd C, Sobin A (1988) Origin of the choanal polyp. Arch Otolaryngol Head Neck Surg 114:1270–1271

    Article  PubMed  CAS  Google Scholar 

  6. Browning AC, Sim KT, Timms JM, Vernon SA, McConachie NS, Allibone R, Jones NS (2006) Successful treatment of invasive cavernous sinus aspergillosis with oral itraconazole monotherapy. J Neurophthalmol 26(2):103–106

    Article  Google Scholar 

  7. Buckley RH (1975) Clinical and immunologic features of selective IgA deficiency. Birth Defects Orig Artic Ser 11:134–142

    PubMed  CAS  Google Scholar 

  8. Cepero R, Smith RJH, Catlin FI, Bressler KL, Furtura GT, Shandera KC (1987) Cystic fibrosis. An otolaryngologic perspective. Otolaryngol Head Neck Surg 97:356–369

    PubMed  CAS  Google Scholar 

  9. Chapel HM; for the Consensus Panel for the Diagnosis and Management of Primary Antibody Deficiencies (1994) Consensus on diagnosis and management of primary antibody deficiencies. Br Med J 308:581–585

    Article  CAS  Google Scholar 

  10. Clement PA (2003) Pediatric endoscopic sinus surgery – does it have a future? Int J Pediatr Otorhinolaryngol 67S1:S209–S211

    Article  Google Scholar 

  11. Crockett DM, MacGill TJ, Friedman EM, Healy GB, Salked LJ (1997) Nasal and paranasal sinus surgery in children with cystic fibrosis. Ann Otol Rhinol Laryngol 96:367–372

    Google Scholar 

  12. Cunningham-Rundles C (1989) Clinical and immunologic analyses of 103 patients with common variable immunodeficiency. J Clin Immunol 9:22–33

    Article  PubMed  CAS  Google Scholar 

  13. Cuyler JP (1992) Follow-up of endoscopic sinus surgery on children with cystic fibrosis. Arch Otolaryngol Head Neck Surg 118:505–506

    Article  PubMed  CAS  Google Scholar 

  14. Davidson TM, Murphy C, Mitchell M, Smith C, Light M (1995) Management of chronic sinusitis in cystic fibrosis. Laryngoscope 105:354–358

    Article  PubMed  CAS  Google Scholar 

  15. Doull IJM (2001) Recent advances in cystic fibrosis. Arch Dis Child 85:62–66

    Article  PubMed  CAS  Google Scholar 

  16. Dudley JP, Welch MJ, Stiehm ER, Carney JM (1982) Scanning and transmission electron microscopic aspects of the nasal acilia syndrome. Laryngoscope 92:297–299

    PubMed  CAS  Google Scholar 

  17. Eliasson R, Mossberg B, Camner P, Afzelius BA (1977) The immotile cilia syndrome. A congenital abnormality as an etiologic factor in chronic airway infections and male sterility. N Engl J Med 297:1–7

    Article  PubMed  CAS  Google Scholar 

  18. Freitas MR, Giesta RP, Pinheiro SD, Silva VC (2006) Antrochoanal polyp: a review of sixteen cases. Rev Bras Otorrinolaryngol (Engl Ed) 72(6):831–835

    Google Scholar 

  19. Gysin C, Alothman GA, Papsin BC (2000) Sinonasal disease in cystic fibrosis: clinical characteristics, diagnosis, and management. Paediatr Pulmonol 30:481–489

    Article  CAS  Google Scholar 

  20. Hadfield PJ, Rowe-Jones JM, Mackay IS (2000) A prospective treatment trial of nasal polyps in adults with cystic fibrosis. Rhinology 38:63–65

    PubMed  CAS  Google Scholar 

  21. Henderson WR Jr, Chi EY (1992) Degranulation of cystic fibrosis nasal polyp mast cells. J Pathol 166:395–404

    Article  PubMed  Google Scholar 

  22. Henriksson G, Westin KM, Karpati F, Wikstrom C-C, Stierna P, Hjelte L (2002) Nasal polyps in cystic fibrosis: clinical endoscopic study with nasal lavage fluid analysis. Chest 121:40–47

    Article  PubMed  Google Scholar 

  23. Hoiby N (2002) New antimicrobials in the management of cystic fibrosis. J Antimicrob Chemother 49:235–238

    Article  PubMed  CAS  Google Scholar 

  24. Hong SK, Min YG, Kim CN (2001) Endoscopic removal of the antral portion of antrochoanal polyp by powered instrumentation. Laryngoscope 111:1774–1778

    Article  PubMed  CAS  Google Scholar 

  25. Hulka GF (2000) Head and neck manifestations of cystic fibrosis and ciliary dyskinesia. Otolaryngol Clin North Am 33:1333–1341

    Article  PubMed  CAS  Google Scholar 

  26. Irving RM, McMahon R, Clark R, Jones NS (1997) Cystic fibrosis transmembrane conductance regulator gene mutations in severe nasal polyposis. Clin Otolaryngol 22:519–521

    Article  PubMed  CAS  Google Scholar 

  27. Jaffe A, Francis J, Rosenthal M (1998) Long-term azithromycin may improve lung function in children with cystic fibrosis. Lancet 351:420

    Article  PubMed  CAS  Google Scholar 

  28. Jones NS (1999) Current concepts in the management of paediatric rhinosinusitis. J Laryngol Otol 113:1–9

    PubMed  CAS  Google Scholar 

  29. Keck T, Rozsasi A (2007) Medium-term symptom outcomes after paranasal sinus surgery in children and young adults with cystic fibrosis. Laryngoscope 117:475–479

    Article  PubMed  Google Scholar 

  30. Kobayashi T, Baba S (1992) Topical use of antibiotics for paranasal sinusitis. Rhinology 14(suppl):77–81

    CAS  Google Scholar 

  31. Kuhn FA, Javer AR (2000) Allergic fungal sinusitis: a four year follow-up. Am J Rhinol 14:149–156

    Article  PubMed  CAS  Google Scholar 

  32. Kuhn FA, Swain R Jr (2003) Allergic fungal sinusitis: diagnosis and treatment. Curr Opin Otol Head Neck Surg 11(1):1–5

    Article  Google Scholar 

  33. Kupferberg SB, Bent JP, Kuhn FA (1997) The prognosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg 117:35–41

    Article  PubMed  CAS  Google Scholar 

  34. Lee TJ, Huang SF (2006) Endoscopic sinus surgery for antrochoanal polyps in children. Otolaryngol Head Neck Surg 135(5):688–692

    Article  PubMed  Google Scholar 

  35. Lessa MM, Voegels RL, Pádua F, Wiikmann C, Romano FR, Butugan O (2002) Sphenochoanal polyp: diagnosis and treatment. Rhinology 40:215–216

    PubMed  Google Scholar 

  36. Lindstrom DR, Conley SF, Splaingard ML, Greshan WM (2007) Ibuprofen therapy and nasal polyposis in cystic fibrosis patients. J Otolaryngology 36(5):309–314

    Article  Google Scholar 

  37. Mason JDT, Beasley NJP, Adler J, Davis SS, Illum L, Jones NS (1996) Measurement of mucociliary transport rates on isolated human nasal mucosa. Clin Otolaryngol 21:377–382

    Article  Google Scholar 

  38. Min YG, Chung JW, Shin JS (1995) Histological structure of antrochoanal polyps. Acta Otolaryngol 115:543–547

    Article  PubMed  CAS  Google Scholar 

  39. Mirza S, Thaper A, McLelland L, Jones NS (2005) Sinonasal cerebrospinal fluid leaks: management of 97 patients over 10 year. Laryngoscope 115:1774–1777

    Article  PubMed  CAS  Google Scholar 

  40. Mirza S, Bradley PJ, Acharya A, Stacey M, Jones NS (2007) Sinonasal inverted papillomas: recurrence, synchronous and metachronous malignancy. JLO 121:857–864

    Article  CAS  Google Scholar 

  41. Myatt HM, Cabrera M (1996) Bilateral antrochoanal polyps in a child: a case report. J Laryngol Otol 110:272–274

    Article  PubMed  CAS  Google Scholar 

  42. Nager GT (1987) Cephaloceles. Laryngoscope 97:77–84

    Article  PubMed  CAS  Google Scholar 

  43. Nishioka GJ, Barbero GJ, König P (1995) Symptom outcome after functional endoscopic sinus surgery in patients with cystic fibrosis: a prospective study. Otolaryngol Head Neck Surg 113:440–445

    Article  PubMed  CAS  Google Scholar 

  44. Parsons D (1992) Sinusitis and cystic fibrosis. In: Lusk RP (ed) Pediatric sinusitis. Raven, New York, p 65

    Google Scholar 

  45. Pedersen H, Mygind N (1976) Absence of axonemal arms in the nasal mucosal cilia in Kartagener’s syndrome. Nature 262:494–495

    Article  PubMed  CAS  Google Scholar 

  46. Pialoux R, Coffinet L, Derelle J, Jankowski R (1999) Does idiopathic naso-sinusal polyposis exist in children? Arch Pediatr 6(4):391–397

    Article  PubMed  CAS  Google Scholar 

  47. Polmar SH (1992) The role of the immunologist in sinus disease. J Allergy Clin Immunol 90(3):511–515

    Article  PubMed  CAS  Google Scholar 

  48. Rains BM III, Mineck CW (2003) Treatment of allergic fungal sinusitis with high dose itraconazole. Am J Rhinol 17:1–8

    PubMed  Google Scholar 

  49. Rains Jonathon D, Lund V, Milroy C (1989) Allergic aspergillus sinusitis – an overlooked diagnosis? JLO 103:1181–1183

    Article  Google Scholar 

  50. Ramsey BW, Dorkin HL, Eisenberg JD (1993) Efficacy of aerosolized Tobramycin in patients with cystic fibrosis. New Engl J Med 328:1740–1746

    Article  PubMed  CAS  Google Scholar 

  51. Raynor EM, Butler A, Guill M, Bent JP III (2000) Nasally inhaled dornase alfa in the postoperative management of chronic sinusitis due to cystic fibrosis. Arch Otolaryngol Head Neck Surg 126:581–583

    PubMed  CAS  Google Scholar 

  52. Riordan J, Rommens J, Kerem BS et al (1989) Identification of the cystic fibrosis gene: cloning and characterization of complementary DNA. Science 245:1066–1073

    Article  PubMed  CAS  Google Scholar 

  53. Rommens J, Iannuzzi M, Kerem BS et al (1989) Identification of the cystic fibrosis gene: chromosome walking and jumping. Science 245:1059–1065

    Article  PubMed  CAS  Google Scholar 

  54. Sato K, Nakashima T (2000) Endoscopic sinus surgery for chronic sinusitis and antrochoanal polyp. Laryngoscope 110:1581–1583

    Article  PubMed  CAS  Google Scholar 

  55. Schaffer FM, Monteiro RC, Volanakis JE, Cooper MD (1991) IgA deficiency. Immunodefic Rev 3:15–44

    PubMed  CAS  Google Scholar 

  56. Schick B, Draf W, Kahle G, Weber R, Wallenfang T (1997) Occult malformations of the skull base. Arch Otolaryngol Head and Neck Surg 123:77–80

    Article  CAS  Google Scholar 

  57. Schramm VL, Effron MZ (1980) Nasal polyps in children. Laryngoscope 90:1488–1495

    PubMed  Google Scholar 

  58. Schulte DL, Kasperbauer JL (1998) Safety of paranasal sinus surgery in patients with cystic fibrosis. Laryngoscope 108:1813–1815

    Article  PubMed  CAS  Google Scholar 

  59. Shapiro GG, Rachelefsky GS (1992) Introduction and definition of sinusitis. J Allergy Clin Immunol 90:417–418

    Article  PubMed  CAS  Google Scholar 

  60. Stern RC, Boat TF, Wood RE, Mathews LW, Doershuk CF (1982) Treatment and prognosis of nasal polyps in cystic fibrosis. Am J Dis Child 136:1067–1070

    PubMed  CAS  Google Scholar 

  61. Stevens DA (2000) A randomised trial of itraconazole in allergic bronchopulmonary aspergillosis. NEJM 342:756–762

    Article  PubMed  CAS  Google Scholar 

  62. Sturgess JM, Chao J, Wong J, Aspin N, Turner JAP (1979) Cilia with defective radial spokes: a cause of impaired ciliary motility. N Engl J Med 300:53–56

    Article  PubMed  CAS  Google Scholar 

  63. Sturgess JM, Chao J, Turner JAP (1980) Transposition of ciliary microtubules: another cause of impaired ciliary motion. N Engl J Med 303:318–322

    Article  PubMed  CAS  Google Scholar 

  64. Toss MC, Thomsen J (1977) Nasal polyps in cystic fibrosis. J Laryngol Otol 91:827–835

    Article  Google Scholar 

  65. Triglia JM, Bellus JF (1992) Nasal polyposis in children. Diagnostic and therapeutic problems. Ann Pediatr (Paris) 39(8):473–477

    CAS  Google Scholar 

  66. Triglia J-M, Nicollas R (1997) Nasal and sinus polyposis in children. Laryngoscope 107:963–966

    Article  PubMed  CAS  Google Scholar 

  67. Varon R, Magdorf K, Staab D, Wahn H, Krawczak L, Sperling K, Reis A (1995) Recurrent nasal polyps as a monosymptomatic form of cystic fibrosis associated with a novel in-frame deletion (591del18) in the CFTR gene. Hum Mol Genet 4:1463–1464

    Article  PubMed  CAS  Google Scholar 

  68. Vevaina JR, Teichberg S, Buschman D (1987) Correlation of absent inner dynein arms and mucociliary clearance in a patient with Kartagener’s syndrome. Chest 91:91–95

    Article  PubMed  CAS  Google Scholar 

  69. Wang EEL, Einarson TR, Keller JD, Conly JM (1999) Antibiotic prescribing for Canadian preschool children: evidence of overprescribing for viral respiratory infections. Clin Infect Dis 29:155–160

    Article  PubMed  CAS  Google Scholar 

  70. WHO (1997) Primary immunodeficiency diseases. Report of a WHO scientific group. Clin Exp Immunol 109(suppl 1):1–28

    Google Scholar 

  71. Williamson R (1993) Universal community carrier screening for cystic fibrosis? Nat Genet 3:195–201

    Article  PubMed  CAS  Google Scholar 

  72. Wolf G, Greistorfer K, Kaink J (1994) Unser erfahrungen mit der endoskopisch-endonasalen operationstechnik bei der therapie der sinusitis im kindesalter. Laryngol Rhinol Otol 73:258–263

    Article  CAS  Google Scholar 

  73. Yamada T, Fujieda S, Mori S (2000) Macrolide treatment decreased the size of nasal polyps and IL-8 levels in nasal lavage. Am J Rhinol 14:143–148

    Article  PubMed  CAS  Google Scholar 

  74. Yung MW, Gould J, Upton GJ (2002) Nasal polyposis in children with cystic fibrosis: a long-term follow-up study. Ann Otol Rhinol Laryngol 111(12 pt1):1081–1086

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nick S. Jones .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Jones, N.S. (2010). Nasal Polyposis in Children: A Differential Diagnosis and Algorithm. In: Önerci, T., Ferguson, B. (eds) Nasal Polyposis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11412-0_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-11412-0_18

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-11411-3

  • Online ISBN: 978-3-642-11412-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics