Nasal polyp antrochoanal polyp ethmoid polyp

Nasal polyp

1. NASAL POLYPS

2. Definition Hypertrophied, edematous, pedunculated mucosa prolapsing out of nose or paranasal sinuses

3. Pathology

4. Antrochoanal Polyp (Killian’s Polyp) It arises from mucosa of maxillary antrum near its accessory ostium, comes out of it, and grows in the choana and nasal cavity. It consists of three parts: i . Antral: A thin stalk ii. Nasopharyngeal: Round and globular iii. Nasal: Flat from side to side.

5. Etiology Nasal allergy along with sinus infection . Seen in children and young adults. Usually unilateral and single.

6. Symptoms Unilateral nasal obstruction Bilateral nasal obstruction -when polyp grows into the nasopharynx -starts obstructing the opposite choana Thick and dull voice – hyponasality Nasal discharge- mostly mucoid

7. Signs On anterior rhinoscopy – sometimes it may be missed as it grows posteriorly Large, smooth, greyish mass covered with nasal discharge. Soft and mobile May protrude from nostril -pink and congested

8. On posterior rhinoscopy -globular mass filling the choana or nasopharynx -a large polyp may sometimes be also seen hanging down in the oropharynx.

9. Investigations Nasal endoscopy -may reveal choanal or antrochoanal polyp hidden posteriorly in the nasal cavity

10. X ray of PNS -show opacity of the involved antrum Lateral view xray -column of air behind the polyp

11. Bilateral Ethmoidal Polyposis Common sites of origin are -uncinate process, -bulla ethmoidalis , -ostia of sinuses and -medial surface and edge middle turbinate. Nasal polyps usually never arise from the septum or the floor of nose.

12. Etiology Inflammatory conditions of nasal mucosa -Rhinosinusitis Disorders of ciliary motility Kartagener’s syndrome Abnormal composition of nasal mucus - Cystic fibrosis

13. Various diseases associated are - Chronic rhinosinusitis Kartagener syndrome: Bronchiectasis, sinusitis, situs inversus and ciliary dyskinesis. - Young’s syndrome: Sinopulmonary disease and azoospermia. Churg-Strauss syndrome: Asthma, fever, eosinophilia, vasculitis and granuloma Samter’s triad: It is the triad of nasal polyps, asthma and aspirin intolerance. Allergic fungal sinusitis.

14. Symptoms Mostly seen in adults Nasal stuffiness- leading to total nasal obstruction Partial/ Total loss of smell Headache Sneezing and watery nasal discharge Protruding mass

15. Signs On anterior rhinoscopy, polyp looks like: -smooth glistening -grape like masses -pale in colour -sessile or pedunculated -insensitive to probe -does not bleed on touch -multiple and bilateral

16. Investigations On Nasal endoscopy

17. On CT

18. Differential Diagnosis Bleb of mucus: -It disappears on blowing the nose. b. Hypertrophied middle turbinate: -It is pink in color -hard like bone on probe testing.

19. c. Angiofibroma: It occurs in adolescent male profuse recurrent episodes of epistaxis. Easily bleeds on touch d. Neoplasms: -fleshy pink appearance -friable nature -tendency to bleed

20. Treatment Conservative Antihistamines -may revert early polypoidal changes with edematous mucosa to normal Short course of steriods

21. Surgical Currently almost all the polyps, which do not respond to medical treatment, are managed by ESS. Snare -Solitary pedunculated polyp can be removed with snare. -Krause’s nasal snare is used for removal of nasal polyps and partial turbinectomy. The polyp mass is engaged in the wire loop and avulsed FESS

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