The medical and surgical treatment of nasal polyps

The work of Kern and Schenck introduced the concept that the nasal polyp was allergic in origin. The ethmoid sinus mucosa is the most common target organ for this allergic reaction leading to the formation of polyps with subsequent nasal obstruction. Patients with nasal polyposis complain of nasal obstruction and may have hyperplastic sinusitis associated with this. This purulent infection compounds the problem of management in these cases. A thorough history and physical examination is necessary to make this diagnosis. X‐ray examinations of the nose and paranasal sinuses are essential to formulate a rational plan of management. Therapy should include an allergic evaluation and a plan of allergic management. Surgical management in the past has included nasal polypectomy as the chief mode of therapy in providing temporary relief of the nasal obstruction. Radical, destructive intranasal and paranasal sinus surgery has led to unnecessary and quite severe complications and mortality, and is to be condemned. Ethmoidectomy, and when indicated, a Caldwell‐Luc procedure will provide drainage of infection, removal of necrotic tissue and necrotic bone when hyperplastic sinusitis complicates the picture. Intrapolyp injection of corticosteroids has proven of great benefit for less severe cases of nasal polyposis without infection. This treatment may need to be repeated in order to achieve the desired relief from nasal obstruction but is only active locally and does not produce systemic side effects. This mode of therapy may be supplemented by oral corticosteroids and by the use of systemic antibiotics. Intranasal mechanical obstruction other than nasal polyps should be corrected by rational surgery to the nasal septum and turbinates. A thorough workup and evaluation is necessary for a plan of management and any therapy, whether medical or surgical, must be based on this type of thorough evaluation of the patient's problem.