Related Subjects:
|Assessing Hearing Loss
|Benign Paroxysmal Positional Vertigo (BPPV)
|Cholesteatoma
|Epistaxis (Nosebleeds)
|Acute Mastoiditis
|Nasal polyps
|Acute Sinusitis
|Sudden Sensorineural Hearing loss (SNHL)
|Causes of Vertigo
📖 About
- Nasal polyps = soft, benign, painless swellings of the nasal/sinus mucosa due to chronic inflammation.
- Strongly associated with asthma, atopy (allergic rhinitis), and cystic fibrosis.
- Also seen in AERD (Aspirin-Exacerbated Respiratory Disease) → triad of asthma, nasal polyps & aspirin sensitivity.
🩺 Clinical Features
- Peak in men >40 yrs; rare in children (⚠️ think cystic fibrosis if present).
- Symptoms: persistent nasal blockage, hyposmia/anosmia, postnasal drip, snoring, facial pressure.
- Voice may sound nasal; chronic mouth breathing possible.
- On endoscopy: smooth, glistening, translucent masses (unlike inflamed turbinates, which are red and painful).
🔎 Investigations
- Clinical exam / nasal endoscopy → confirms diagnosis.
- CT sinus → extent of disease, pre-surgery planning.
- MRI if malignancy or atypical lesion suspected.
- Cystic fibrosis testing if child with polyps.
- Allergy testing if strong atopic background.
💊 Management
- First line – intranasal corticosteroids (e.g. fluticasone, mometasone) → shrink polyps, reduce recurrence.
- Short oral corticosteroid course if severe or refractory symptoms.
- Surgery – functional endoscopic sinus surgery (FESS) if medical therapy fails or obstruction severe.
- Biologics (dupilumab, mepolizumab) → newer option in refractory cases with asthma/AERD.
- Adjuncts: saline nasal irrigation, avoidance of triggers (smoke, allergens, NSAIDs if sensitive).
📊 Prognosis & Follow-Up
- Recurrence common → long-term steroid spray often needed post-surgery.
- Monitor patients with asthma or aspirin sensitivity closely (risk of severe airway disease).
- In children → always consider and investigate for underlying cystic fibrosis.
📌 Exam / OSCE Pearls
- ⚠️ Child with nasal polyps → always exclude cystic fibrosis.
- Nasal polyps are pale, bilateral, non-tender masses (contrast with unilateral red mass → suspect tumour).
- AERD = Asthma + Nasal polyps + Aspirin sensitivity.
📚 References
