A 38-year-old man presents with bilateral nasal obstruction and rhinorrhea for 8 months. On anterior rhinoscopy, pale, smooth, glistening masses are seen in both nasal cavities. Which investigation is most appropriate to confirm the diagnosis and assess the extent of disease?

Explanation

## Investigation of Choice for Nasal Polyps ### Clinical Presentation The patient presents with classic features of nasal polyps: - Bilateral nasal obstruction - Rhinorrhea - Pale, smooth, glistening masses on anterior rhinoscopy ### Why CT Paranasal Sinuses is the Gold Standard **Key Point:** CT of paranasal sinuses is the investigation of choice for nasal polyps because it: 1. Confirms the diagnosis 2. Assesses the extent and location of polyps 3. Evaluates associated sinusitis 4. Detects complications (orbital extension, intracranial involvement) 5. Guides surgical planning if needed ### CT Findings in Nasal Polyps | Finding | Characteristic | |---------|----------------| | Density | Low to intermediate (soft tissue) | | Enhancement | Mild homogeneous enhancement | | Location | Usually from maxillary or ethmoid sinuses | | Bilateral involvement | Common in allergic polyps | | Bone erosion | Rare; suggests malignancy if present | **High-Yield:** CT is superior to plain radiographs because it provides: - 3D spatial resolution - Clear delineation of polyp extent - Assessment of sinus involvement - Detection of complications ### Role of Nasal Endoscopy **Clinical Pearl:** While nasal endoscopy is the initial diagnostic tool (visualizes polyps directly), biopsy is reserved only for: - Unilateral polyps (to rule out malignancy) - Atypical appearance - Polyps in children (suggests cystic fibrosis) Biopsy is NOT routinely needed for typical bilateral nasal polyps. ### Differential Imaging - **Plain X-ray:** Insensitive; cannot visualize soft tissue detail - **MRI:** Reserved for suspected intracranial or orbital complications; not first-line - **Biopsy:** Not indicated for typical bilateral polyps; increases morbidity