Sinonasal polyposis

Last revised by Henry Knipe on 10 Nov 2022

Sinonasal polyposis refers to the presence of multiple benign polyps in the nasal cavity and paranasal sinuses.

Sinonasal polyposis is most commonly encountered in adults and rare in children. Polyps are the most common expansile lesions of the nasal cavity 8.

Conditions known to be associated with polyps include 10:

Clinical symptoms of sinonasal polyposis may include progressive nasal obstruction, rhinorrhea, facial pain, headache, anosmia, etc. 3. It can also cause a particular pattern of chronic sinusitis as a result of obstruction of the drainage pathways of the paranasal sinuses.

Polyps are formed by the influx of fluid into the lamina propria of the sinonasal Schneiderian mucosa 8,9.

The Meltzer grading system is a clinical grading system that is as follows ref:

  • grade 0: no visible polyposis

  • grade 1: single polyp confined to the middle meatus

  • grade 2: multiple polyps in the middle meatus

  • grade 3: extending beyond the middle meatus

  • grade 4: nasal cavity obstruction

  • extensive mucosal polyps occupying and obliterating the nasal cavity and the paranasal sinuses

    • usually, they are hypodense but may be hyperdense due to increased protein content or fungal infection

  • associated local benign bone remodeling or erosion (as opposed to a mucocele where the entire sinus is expanded 6)

    • enlargement of infundibula

    • attenuation of the ethmoid sinus walls and nasal septum

    • occasionally sparing the inferior nasal meatus

    • truncation of middle turbinate 4

  • opacified ethmoid sinuses with convex lateral walls and gas-fluid levels

  • a concurrent fungal sinus infection may be present

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