Clinical guide - Aural polyps
This is a guide to the management of aural polyps. As with all guidance, it simplifies the problem and should always be supplemented by other reading on anatomy and pathophysiology. Its purpose is to give you guidance only – it is not a set of unchangeable rules.
In general, aural polyps arise from an area of infection in mucosa, skin or bone. Very rarely they are malignant. Your treatment should be aimed at reducing the size of the polyp and identifying where it has come from and what the diagnosis is. Examples of possible diagnoses are: perforated drum with middle ear polyp, cholesteatoma, malignant otitis externa and foreign body.
Some polyps cannot be treated simply in the clinic and these you should refer for examination under anaesthetic at the ENT hospital, if possible.
The principles of polyp management are simple:
Take a careful history and do a thorough examination
Clean the ear of pus and debris (never pull on a polyp if you don’t know what it is attached to)
Use medication to shrink the polyp (see below)
Review the patient and repeat the steps above until the polyp has gone and the diagnosis is made
Continue to treat the underlying diagnosis, if possible, or refer for surgery
The medications that you use will depend upon local availability and the advice below is based upon drugs available at the time of writing. No silver nitrate solution or sticks can be found and the advice uses drugs only.
If you can easily see the eardrum then the polyp is probably small. In this case you can use an antibiotic drop mixed with steroid for management. Polydexa drops are appropriate. Use for seven days then review the patient to see whether the polyp has shrunk and then diagnose the underlying condition if not already known
These fill the ear canal and you cannot see past them to diagnose their cause. In this case drops are less likely to be successful. Use a Gentamicin, steroid and clotrimazole cream in this situation. Place it all around the polyp and medial to it if you can. Review in seven days to see if it has shrunk. If it has you can swap to polydexa, if it hasn’t repeat the cream treatment.
If the large polyp will not get smaller, refer the patient to the ENT hospital.
If a polyp is large you cant see where it comes from. It may be attached to the stapes head or the facial nerve through a perforation. Don't try to remove the polyp. You may cause sensory deafness or facial paralysis.