How can I differentiate between nasal polyps and other causes of nasal obstruction in patients?

To differentiate nasal polyps from other causes of nasal obstruction, a thorough clinical assessment combined with targeted examination is essential. Nasal polyps typically present as pale, edematous, and bilateral masses visible on anterior rhinoscopy or nasal endoscopy, often associated with chronic rhinosinusitis and allergic conditions, whereas other causes such as septal deviation, turbinate hypertrophy, or neoplasms have distinct appearances and clinical features NICE NG202.

Key clinical features suggesting nasal polyps include: persistent nasal obstruction, anosmia or hyposmia, and a history of asthma or aspirin sensitivity, which are less common in other causes of obstruction NICE NG202.

Examination: Nasal endoscopy is the gold standard to visualize polyps, which appear as smooth, gelatinous masses arising from the middle meatus or ethmoidal region, differentiating them from inferior turbinate hypertrophy or septal deviations that cause mechanical obstruction without polypoid tissue NICE NG202.

Imaging: CT scanning of the sinuses can help distinguish polyps by showing soft tissue opacification with expansion of the sinus cavities, unlike bony deformities seen in septal deviation or isolated turbinate enlargement Facon et al. 2004Cingi et al. 2011.

Other differential diagnoses to consider include: antrochoanal polyps, which are usually unilateral and arise from the maxillary sinus; inferior turbinate hypertrophy, which presents as firm, non-translucent swelling; and neoplastic lesions, which may have irregular surfaces and bleeding Goldfarb et al. 2017.

In summary, combining patient history, nasal endoscopy findings, and imaging allows differentiation of nasal polyps from other causes of nasal obstruction, guiding appropriate management NICE NG202 Facon et al. 2004Cingi et al. 2011Goldfarb et al. 2017.