Nasal Polyps in Children — Causes, Symptoms and Treatment

What are nasal polyps?

Nasal polyps are benign, soft, translucent or grey-reddish growths that develop from the inflamed mucosa of the nasal cavities or paranasal sinuses. They result from a chronic inflammatory process of the mucosa, which leads to oedema and protrusion into the nasal cavity.

In children, nasal polyps are significantly rarer than in adults. Their presence in a child always warrants further investigation, as they may be associated with systemic conditions such as cystic fibrosis (mucoviscidosis) or primary ciliary dyskinesia.

Causes and risk factors

Factors contributing to nasal polyp formation in children include:

• Cystic fibrosis — up to 40-50% of children with nasal polyps have cystic fibrosis; testing is mandatory
• Allergic rhinitis — chronic inflammation of the nasal mucosa
• Chronic sinusitis — persistent sinus infection
• Primary ciliary dyskinesia — a genetic defect of the respiratory mucosal cilia
• Aspirin intolerance — rare in children but possible (Samter's triad)
• Genetic predisposition

Symptoms

Nasal polyps cause symptoms that progressively worsen as they increase in size:

• Nasal obstruction — bilateral, progressive, permanent
• Rhinorrhoea (nasal discharge) — persistent, mucous or mucopurulent
• Hyposmia or anosmia (reduced or complete loss of smell)
• Constant mouth breathing
• Nasal voice
• Facial pressure or headache
• Snoring and sleep disturbances
• Chronic cough due to postnasal drip

Diagnosis

Diagnosing nasal polyps in children involves:

• ENT examination — anterior rhinoscopy can reveal polyps in the nasal cavity
• Nasal endoscopy — detailed visualisation of the nasal cavities and sinus meati
• Sinus CT scan — assessment of polyp extension into the sinuses
• Sweat test (chloride test) — mandatory in children with nasal polyps to rule out cystic fibrosis
• Allergy testing — identification of allergic sensitisations

Treatment

Medical treatment

• Topical nasal corticosteroids — first-line treatment: mometasone, fluticasone; can reduce polyp size
• Short courses of oral corticosteroids — for rapid reduction of polyp volume
• Nasal lavage with hypertonic saline solution
• Treatment of the underlying condition (cystic fibrosis, allergy)

Surgical treatment

Endoscopic nasal polypectomy is indicated when medical treatment fails to control symptoms. The procedure is performed under general anaesthesia using minimally invasive endoscopic techniques. Recurrence is possible, especially if the underlying condition is not controlled.

When to see a doctor

Schedule an ENT consultation if:

• Your child has persistent bilateral nasal obstruction that does not respond to treatment
• You notice chronic nasal discharge
• Your child has lost the sense of smell
• Your child breathes exclusively through the mouth