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Clinical guide - Unilateral Nasal Polyp

This short guide is regarding the unilateral nasal polyp. It should be read in conjunction with the tutorial of the same name and with background reading on nasal conditions. It is brief and pragmatic and applies to AEC clinicians in 2018.

 

General Information.

 

The commonest causes of a unilateral nasal polyp are chronic rhinosinusitis and non-allergic rhinitis. However, unlike bilateral polyps, unilateral polyps may be neoplastic in origin. Most neoplasms will be benign but some will be malignant.

 

Knowledge of the anatomy of the nose and adjacent structures is essential before using this guidance.

 

On first seeing a patient with a possible unilateral polyp.

 

At first presentation you must make a careful endoscopic examination of both sides of the nose. Use Otrivine nasal spray to decongest the nose and use the rigid endoscope as you have been taught. You may find a small polyp hidden from view on the other side of the nose. If you do, treat the patient as for bilateral polyps.

 

If no polyps have been found on the opposite side of the nose then you can confidently diagnose a unilateral polyp. Next, you must:

 

  1. Examine eye movements

  2. Test for facial sensation over the forehead, cheek and lower jaw

  3. Examine the hard palate and upper alveolus

  4. Examine the patient’s neck

 

What is the next step?

 

You have a choice. You can refer directly to the ENT department of your local hospital or you can start a short course of medical management of the case.

Only consider treating the polyp if it looks completely normal for an inflammatory polyp. If it looks at all abnormal or if eye movements are abnormal, there are loose teeth in gah supper jaw on the same side, if there is unilateral facial swelling or numbness, refer without delay.

 

If you choose to start a short course of treatment you should use:

 

  1. Topical nasal steroids if the unilateral polyp is small

  2. Oral dexamethasone 6mg daily OR Prednisolone 1mg / kg/day (up to 40mg daily), if the unilateral polyp is large

 

Whichever you choose you must only offer a short course of treatment. Nasal sprays should be used for no more than two months. Then the nose, face, mouth and neck must be re-examined and the patient referred if necessary.

 

If using oral steroid do this for ten days only. If the polyp is shrinking give the patient topical sprays to try for two months (as above). If it isn’t shrinking refer immediately.