. The Epidemiological and Clinical Aspects of Nasal Polyps that Require Surgery.

Abstract

The objective of this retrospective cross-sectional study was to obtain epidemiological data from the charts of 297 patients with nasal polyposis who were operated on in a referral hospital in Mashhad and to determine the frequency of the presenting symptoms of nasal polyps.
The variables recorded included age, gender, the presence of asthma or allergic rhinitis, family history, and previous treatments. We studied the main symptoms of nasal polyposis (nasal obstruction, rhinorrhea, anosmia, headache, epistaxis, snoring, and so on), as well as ear problems and facial deformity.
Nasal polyposis affects men (60.3%) more frequently, at a mean age of 39.5 years. The most frequent symptom was nasal blockage (81.1 %) followed by rhinorrhea (37.7%). A total of 11.1% of the patients had a history of epistaxis. Asthma was found in 10.4% of patients with nasal polyposis and the ears were affected in 5.1% of patients. In all, 7.4% of patients had first-degree relatives who suffered from asthma or allergic rhinitis.
This study highlights the need for large-scale epidemiologic research exploring the prevalence and incidence of nasal polyposis in Iran.

Full text

Iranian Journal of Otorhinolaryngology
No.2, Vol.24, Serial No.67, Spring-2012
75
Original Article
The Epidemiological and Clinical Aspects of Nasal Polyps That
Require Surgery
Meymane Jahromi Ahmad1,*Shahabi Ayeh2
Abstract
Introduction:
The objective of this retrospective cross-sectional study was to obtain epidemiological data
from the charts of 297 patients with nasal polyposis who were operated on in a referral
hospital in Mashhad and to determine the frequency of the presenting symptoms of nasal
polyps.
Materials and Methods:
The variables recorded included age, gender, the presence of asthma or allergic rhinitis, family
history, and previous treatments. We studied the main symptoms of nasal polyposis (nasal
obstruction, rhinorrhea, anosmia, headache, epistaxis, snoring, and so on), as well as ear
problems and facial deformity.
Results:
Nasal polyposis affects men (60.3%) more frequently, at a mean age of 39.5 years. The most
frequent symptom was nasal blockage (81.1 %) followed by rhinorrhea (37.7%). A total of
11.1% of the patients had a history of epistaxis. Asthma was found in 10.4% of patients with
nasal polyposis and the ears were affected in 5.1% of patients. In all, 7.4% of patients had
first-degree relatives who suffered from asthma or allergic rhinitis.
Conclusion:
This study highlights the need for large-scale epidemiologic research exploring the prevalence
and incidence of nasal polyposis in Iran.
Keywords:
Clinical features, Epidemiology, Nasal polyposis.
Accepted date: 15 Jun 2011
Received date: 27 Dec 2011
1Assistant Professor of Otolaryngology. Department of Otorhinolaryngology, Imam Reza Hospital, Faculty of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2Otolaryngology Resident. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
*Corresponding author
Address: Imam Reza University Hospital, Ahmadabad Ave, Mashhad, Iran.
Postal Code: 91766-99199
Tel: +98 9122886266
E-mail: shahabipoura871@mums.ac.ir; shahabi.ayeh@yahoo.com

Nasal Polyps
76, Iranian Journal of Otorhinolaryngology No.2, Vol.24, Serial No.67, Spring-2012
Introduction
Nasal polyps are mucosal lesions of the
nasal or paranasal sinuses that can result
from a response to inflammatory or
infectious stimuli. They appear as smooth,
round, semi-translucent masses that are
most commonly found in the middle
meatus and ethmoid sinuses and affect 1%
to 4% of the population. Males are
affected more than females and adults
more than children. If it happens in
childhood, mucociliary and
immunodeficiency diseases must be ruled
out, for example, patients with cystic
fibrosis have a prevalence of nasal
polyposis between 6% and 48% (1).
Patients with nasal polyposis may present
clinically with complaints of nasal
obstruction, congestion, hyposmia,
rhinorrhea, epistaxis, postnasal drip,
headaches, and snoring. Although nasal
polyps more commonly appear bilaterally
they can also present unilaterally. In
unilateral nasal masses, benign or
malignant pathologies must be considered
and distinguished by nasal endoscopy, CT
scan, and biopsy (1).
The etiology of nasal polyps has been the
subject of research for many years.
Elevated levels of histamine and IgE found
around polyps, and mast cells and
eosinophilia found within polyps provide
evidence suggesting that inflammation is a
major factor in polyp formation (2).
Previous studies have also revealed a
relationship between nasal polyposis,
aspirin intolerance, and allergic rhinitis
and asthma (4,5). The prevalence of nasal
polyposis is higher in subjects with asthma
than in non-asthmatics and 16.5% of
asthmatic patients over 40 years of age
have been shown to have nasal polyps (3).
The management of nasal polyposis can
be both medical and surgical. Topical
corticosteroids are drug of choice as they
reduce the size of the polyp and improve
nasal breathing and prevent recurrence. In
patients who do not response to medical
therapy or have large-sized polyps,
functional endoscopic sinus surgery (FESS)
is used to perform a polypectomy (4,5). The
objective of this study was to obtain clinical
data from patients with nasal polyposis who
were managed surgically.
Materials and Methods
We reviewed the hospital charts of 297
patients with nasal polyposis (unilateral
and bilateral) who were operated on
between 1998 and 2002 in our referral
hospital in Mashhad, Iran. The procedures
performed included simple polypectomy,
the Caldwell-Luc procedure, external
ethmoidectomy, and functional endoscopic
sinus surgery (FESS). In all cases, the
patient’s medical history and notes from
an otolaryngological physical examination
were reviewed and a check list of 22
variables was completed. The variables
included age, age of onset, gender, season
of referral, location of nasal symptoms
(bilateral or unilateral). History of allergic
rhinitis, asthma, or cystic fibrosis was
extracted from the hospital records.
Symptoms of nasal polyps such as nasal
obstruction, rhinorrhea, facial pain and
headache, epistaxis, snoring, mouth
breathing, voice changes, ear problems,
and facial deformity due to polyposis were
also included in the check list. Family
history of asthma or allergy and previous
medical or surgical treatments were other
variables that were routinely present in the
hospital records of our patients in the
Otorhinolaryngology ward. All of our
patients had a histologic diagnosis of
inflammatory nasal polyps.
For the quantitative data, descriptive
statistical analysis was conducted to
determine the mean and standard
deviation. For the qualitative data, we
calculated percentages of the recorded
variable. Our study was approved by the
Institutional Board Review of Mashhad
University of Medical Sciences.
Results
Among the 297 patients with nasal
polyps, 118 were female (39.7%) and 179

Iranian Journal of Otorhinolaryngology No.
were male
(60.3%). The average age of the
patients with nasal polyps
included in the
study was 39.49 ±16.63
years old,
range of 7 to 79 years old. The average age
of onset was 29.2 ± 15.93
years old
respect to age and age of onset
polyps were most
common in
decade of life, followed by the third and
then fourth decades.
Most of
occurred in the spring
(36.7%) and
summer (23.2%). In 161
(54.2%)
patients the
polyps were bilateral.
the total number of patients with
polyps, 31
(10.4%) presented
associated asthma and received treatment
54 (18.2%) presented with
allergic
and 22
(7.4%) indicated that they had
first-
degree relative (father/mother,
brother/sister, son/daughter)
who
from asthma or allergy
. None of the
patients
had been diagnosed
fibrosis.
The frequency of the
major symptoms of
nasal p
olyps in the patients studied can be
seen in Figure 1.
Fig 1:
Frequency of major symptoms of nasal
polyps (%)
The most common symptom among
patients was nasal obstruction (81.1%).
our study 11.1% of patients
had
of epistaxis. A total of
15 patients out of
297 (5.1%) had otorrhea
,
symptoms of chronic otitis media
media with effusion according to history,
otoscopy,
and tympanometry.
(2.7%)
their nasal polyps had cause
deformity, 141 patients
(44.1%) had
Iranian Journal of Otorhinolaryngology No.
2, Vol.24
, Serial
(60.3%). The average age of the
included in the
years old,
with a
range of 7 to 79 years old. The average age
years old
. In
respect to age and age of onset
, nasal
common in
the second
decade of life, followed by the third and
Most of
the referrals
(36.7%) and
(54.2%)
of the
polyps were bilateral.
Out of
the total number of patients with
nasal
(10.4%) presented
with
associated asthma and received treatment
,
allergic
rhinitis,
(7.4%) indicated that they had
a
degree relative (father/mother,
who
suffered
. None of the
had been diagnosed
with cystic
major symptoms of
olyps in the patients studied can be
Frequency of major symptoms of nasal
The most common symptom among
patients was nasal obstruction (81.1%).
In
had
a history
15 patients out of
,
signs and
symptoms of chronic otitis media
, or otitis
media with effusion according to history,
and tympanometry.
In 8 patients
their nasal polyps had cause
d facial
(44.1%) had
received medications before surgery,
74
patients (24.9%) had
of polypectomy.
Discussion
Nasal polyposis is a condition that more
commonly affects middle
our study, the pea
k age of presentation was
in the second decade of life and the mean
age of patients was 39.34 ± 16.63 years. In
a Nigerian district hospital, Chukuezi
reported that the maximum presentation
rate was between 31 and 40 years old (7).
In France, the estimated
polyposis increased with age, reaching a
peak in the 50 to 59 year age group (8). In
another study in France the mean age of
patients was 49.4 ± 17.6 (9). Thus, our
patients were younger than in previous
studies.
In the only epidemiolog
nasal polyposis in Iran that we could find,
Hashemian and colleagues reported that the
incidence of polyposis in 192 patients with
chronic rhinosinusitis
as 40%, while the sex
distribution of the patients with polyposis
was 60% male and 40% fem
the patients also had a history of
allergy (10).
Patients with nasal polyposis often
present with
associated asthma. Asthmatic
patients older than 40 years have
times greater risk of suffering nasal
polyposis than those under 40 year
(3).
In addition, Slavin
reported that patients with nasal polyposis
present with
more severe asthma than
those without polyps (11)
asthma was found in 10.4% of patients
rate that was
significantly lower than
found in previous studies in France (45%)
and Spain (36.6%) (12,
13)
In contrast to the association with asthma,
i
t is rare for patients with allergic rhinitis
to present with
nasal polyposis. Settipane
and Chafee found that only 1.5% of
patients with alle
rgic rhinitis had nasal
polyposis and that
it was more common to
find nasal polyposis in patients with non
allergic rhinitis than in those with allergic
Jahromi A, et al
, Serial
No.67, Spring-2012,77
received medications before surgery,
and
patients (24.9%) had
a previous history
Nasal polyposis is a condition that more
commonly affects middle
-aged men (6). In
k age of presentation was
in the second decade of life and the mean
age of patients was 39.34 ± 16.63 years. In
a Nigerian district hospital, Chukuezi
reported that the maximum presentation
rate was between 31 and 40 years old (7).
In France, the estimated
incidence of nasal
polyposis increased with age, reaching a
peak in the 50 to 59 year age group (8). In
another study in France the mean age of
patients was 49.4 ± 17.6 (9). Thus, our
patients were younger than in previous
In the only epidemiolog
ic study of
nasal polyposis in Iran that we could find,
Hashemian and colleagues reported that the
incidence of polyposis in 192 patients with
as 40%, while the sex
distribution of the patients with polyposis
was 60% male and 40% fem
ale and 43% of
the patients also had a history of
Patients with nasal polyposis often
associated asthma. Asthmatic
patients older than 40 years have
a four
times greater risk of suffering nasal
polyposis than those under 40 year
s of age
In addition, Slavin
and colleagues
reported that patients with nasal polyposis
more severe asthma than
those without polyps (11)
. In our study,
asthma was found in 10.4% of patients
, a
significantly lower than
that
found in previous studies in France (45%)
13)
.
In contrast to the association with asthma,
t is rare for patients with allergic rhinitis
nasal polyposis. Settipane
and Chafee found that only 1.5% of
rgic rhinitis had nasal
it was more common to
find nasal polyposis in patients with non
-
allergic rhinitis than in those with allergic

Nasal Polyps
78, Iranian Journal of Otorhinolaryngology No.2, Vol.24, Serial No.67, Spring-2012
rhinitis; a difference that was statistically
significant (4).
In our sample, we found that the
incidence of allergic rhinitis among
patients with nasal polyposis was 18.2% in
contrast to 47.9% in Spanish patients in a
study by Monus (13).
In our patients, 45.8 % had unilateral
nasal polyposis and it was more common in
comparison with other studies such as that
by Tritt and colleagues in which only 46
patients out of 301 patients with nasal
polyposis had unilateral polyps and patients
with unilateral polyps were younger at
presentation (mean age: 35) (1). The lower
incidence of asthma and allergic rhinitis
and younger age of our patients could be
explained by higher number of cases of
unilateral polyps included in our study.
The most common complaint of patients
with nasal polyposis is nasal obstruction.
In our study the most frequent symptoms
were nasal obstruction (81.1%) and
rhinorrhea (37.7%), followed by mouth
breathing and snoring. Hyposmia,
headache and facial pain were less
common. In our study, 11.1% of patients
had a history of epistaxis although it had
the lowest incidence among other
symptoms but it was still high when
comparing other studies. Previous studies
often did not mention this symptom,
probably because of low incidence (14),
but Tritt and colleagues demonstrated that
unilateral epistaxis in the presence of
unilateral nasal polyps is statistically
significant for inverted papilloma (1).
Conclusion
An overview of the currently available
literature illustrates the paucity of accurate
information on the epidemiology of nasal
polyposis especially in Iran, and highlights
the need for large-scale epidemiologic
research exploring the prevalence and
incidence of nasal polyposis.
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