Fact-sheet: Sinonasal polyposis


Updated on 03/26/2020 at 1:58 PM

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Definition

Chronic inflammatory disease of the sinus and nasal mucosa, corresponding to a non-neoplastic inflammatory hypertrophy of the nasosinus mucosa, deforming to form polyps.
Polyps are generally multiple and bilateral but may also be solitary.
The etiopathogenesis is not formally defined.
Etiology: - Cystic fibrosis
- Ciliary dyskinesia
- Fungal-allergic sinusitis
- Idiopathic
May be associated with asthma and aspirin intolerance,
constituting Fernand Widal syndrome.

Clinical features

Revealed by nasal obstruction and progressively worsening anosmia.
Evolves in flares.
If untreated, may become deforming.
On nasal endoscopy, polyps have a fleshy, translucent, and glistening appearance.
Forms without visible polyps: Prepolyposis/NARES
Woakes syndrome: polyp dropping into the nasal vestibule

CT

After endoscopic diagnosis, outside of inflammatory flares.
Reference imaging examination performed without contrast injection.
Classic form:

  • Polypoid masses of the nasal cavities and pan-sinus involvement
  • Erosive bone remodeling of the ethmoidal walls and nasal turbinates

Advanced/complicated form:

  • Acute sinusitis: sinus air-fluid levels (important to specify in the report)
  • Mucocele
  • Pneumosinus dilatans
  • Aspergillus fungus ball
  • Nasofrontal duct stenosis
  • May take on a pseudotumoral appearance, requiring contrast injection

If contrast injection, tissue in hyper- and hypodense layers
Assessment of anatomical variants

MRI

Layered mixture of signals of the nasosinus mucosa producing a cobblestone appearance,
Recent mucus has a fluid signal
Old, thickened mucus is T1/T2 hypointense
Patchy enhancement of the compacted epithelium

Management

Lifelong treatment:
- Baseline: nasal lavage and intranasal corticosteroid therapy
- Flare: oral corticosteroid therapy and antibiotic therapy
- Surgery if treatment fails (20 to 30% of cases): ethmoidectomy

Classification

- Stage 0: not seen
- Stage 1: middle meatus
- Stage 2: middle turbinate
- Stage 3: inferior turbinate

Differential diagnosis

Retention cyst
Fungal-allergic sinusitis
Wegener granulomatosis