polyps in a 10-year-old child

Question

My 10-year-old son more than two years ago underwent for the first time polipectomy (choanal polyp in a right nasal cavity). Since that time he underwent polipectomy twice and right now his nose is blocked again, so I expect more polyps. He is constantly supervised by laryngologist, but I do worry about this fact. Isn't it cystic fibrosis? Once I asked my doctor about it, but he did't proposed any further tests. My son underwent allergic tests, he is allergic to mould and feathers. He is not treated with any drugs. Polyps occur in our family (my husband's family), so I think it is genetic... My son is rarely sick, suffers from common cold also rarely, he never suffered from bronchitis or pneumonia... He used to have flu, sore throats, but during past 18 months he hasn't been sick. He dosesn't cough, weighs 38 kg, has no eating problems. Should I do anything with this?

Answer

Dear Questioner,
Single, unilateral polyp, so called choanal polyp, comprises ca 5% of all nasal polyps and is most common among children and adolescents. It is caused by inflammation (more often) or allergy (rare). Unlike multiple nasal polyps, which are mostly caused by allergy and treatment with steroids and antibiotics is effective in decreasing the size or even elimination of polyps, choanal polyp rarely responds to such treatment and requires surgical operation. Intranasal polypectomy is insufficient and additionally connected with high risk of relapses - this is probably the case of your child. Surgical opening of the maxillary sinus and removal of the polyp’s pedicle radically increases the efficacy of the surgical treatment. This operation can be done using FESS technique (functional endoscopic sinus surgery). One has to remember, that even in children with choanal polyps, who were operated by most experienced laryngologists, higher risk of relapses is observed – 20% of real relapses and 50% of x-ray changes suggesting the possibility of relapse.
In the Literature it is described, that nasal polyps can be a typical sign of the involvement of the upper airways in CF with chronic sinusitis and that the prevalence of nasal polys is between 6-67% in CF patients depending on age. Therefore, sinunasal polyps which occur already in the early childhood, should be a reason for doing a sweat test in order to exclude CF even if the story of your son does not sound like typical CF - it will calm you down if you know for sure that this disease is not behind the symptoms of your son.

I propose to arrange another laryngological consultation and then, if indicated, to perform CT of the sinuses (in special projection), sweat test and further diagnostics, if needed.
Best regards, Jarosław Szydłowski, MD, PhD

08.02.2010