Respiratory Epithelial Adenomatoid Hamartoma: A Frequently Missed Diagnosis
Kathy Philips developed nasal polyps for the first time nearly a decade ago. “All my life I’ve had sinus problems and seasonal allergies,” she says. “I had an allergy workup and discovered I was allergic to the usual suspects – molds and pollens from grasses, weeds, and trees. The polyps came on all at once and were almost growing out of my nose.”
Her ENT excised them. “It was an office procedure and not terrible,” Philips says. “He asked me if I had noticed any loss of smell. I said no, but I went home that night and fried bacon and couldn’t smell the bacon. It dawned on me that I’d gradually lost a good bit of my sense of smell.”
Two or three years later, her nasal polyps recurred. “The second round didn’t go as well, and I wondered if something had changed,” she says. “My ENT prescribed Dupixent, which had just been approved to treat nasal polyps. It should have cured me, but it didn’t.”
An anesthesiologist Philips knows had worked on cases with Martin J. Citardi, MD, and suggested that she see him. Dr. Citardi is professor and chair of the Department of Otorhinolaryngology and vice dean for clinical technology at McGovern Medical School at UTHealth Houston. An internationally recognized ear, nose, and throat surgeon, Dr. Citardi has special interests in refractory sinusitis, revision sinus surgery, CSF rhinorrhea, image-guided surgery, and minimally invasive anterior skull base surgery.
Immediately, he recognized respiratory epithelial adenomatoid hamartoma (REAH), a benign tumor originating from the anterior olfactory cleft in the nasal cavity, which presents like nasal polyps but often goes unnoticed. “The endoscopic appearance of REAH is different from polyps, and it usually occurs in older adults,” he says. “It’s important to recognize it and treat it with surgery.”
Dr. Citardi took Philips to the OR in early 2025. “He was very knowledgeable, knew right away what it was, and wasn’t surprised that the Dupixent didn’t help,” she says. “His expertise and reputation as a skilled surgeon impressed me. The growth was blocking pretty much of my nasal cavity and was visible. The tissue he removed was about the size of a fingernail.”
Philips, who is 80, describes her recovery as unremarkable. “I went home the same day and had no issues. When I went in for my six-month follow-up, he was pleased with my progress. Since the surgery, I’ve had no sinus headaches, which I’ve had off and on for most of my life. Ten years ago, I was living on over-the-counter drugs. Now I live on a golf course and can go out and work in the yard without a problem. The surgery hasn’t stopped my allergies – I’m still sensitized to those allergens, but my reaction is much less. The treatment made a big difference.”