Nasal polyposis

Nasal polyposis

1. NASAL POLYPOSIS Moderator -Dr.Jyothi Swarup Presenter-Dr.Razal 1

2. Definition Nasal polyp are non-neoplastic mass of edematous nasal or sinus mucosa. An inflammatory reaction involving the mucous membrane of nose ,the paranasal sinus ,often lower airways. Presents with grape like appearance having a body and a stalk. 2

3. Epidemiology Prevalence rate is about 1-4% Increase with the age(peak at the age of 50 s Male: Female ratio is about 2:1 3

4. Histo- p athology Histologically, nasal polyps are characterized by a pseudostratified ciliated columnar epithelium and few nerve endings. The stroma of nasal polyps is edematous. Eosinophil cells are the most commonly identified inflammatory cell, occurring in 80-90% of polyps. Neutrophils in 7% of polyps 4

5. Sites Commonest sites in order of frequency are ; Ethmoids Maxillary antrum Sphenoids 5

6. Causes Allergic rhinitis, Allergic fungal sinusitis Asthma-7% of patient shows polyp Cystic fibrosis (disease of Exocrine glands) Kartagener syndrome (Bronchiectasis,Chronic Sinusitis situs inversus,ciliary dyskinesia) Nickel exposure Young’s Syndrome- It consists of chronic rhiniosinusitis, nasal polyposis, bronchiectasis and azoospermia . Churg-Strauss Syndrome- Affects small to medium-sized arteries and veins. 6

7. The Aspirin triad A triad of nasal polyposis ,asthma and aspirin intolerance. It is a non allergic entity. 7

8. ETHMOIDAL POLYP Multiple polyps always arise from lateral wall of nose, usually from middle meatus. Common sites are uncinate process, bulla ethmoidalis, medial surface of middle turbinate 8

9. Symptoms Nasal obstruction bilaterally. Partial or total loss of smell Headache Sneezing(Excessive) / watery nasal discharge 9

10. Signs Smooth, glistening, grapelike masses, Multiple and bilateral. Often greyish -pale in color, long standing polyps may appear pinkish. May be sessile or pedunculated , insensitive to touch, does not bleed on touch and probe can be passed all around the mass. Long standing cases may present with broadening of nose and increase in inter-canthal distance. 10

11. Anterior Rhinoscopy Nasal Endoscopy Findings 11

12. Differential Diagnosis Hypertrophied turbinates (pink in colour,sensitive to touch, probe cannot be passed laterally) Inverted papilloma- Irregular surface, pink in color, common in middle aged female and arises from lateral wall. Malignant tumors- Blood tinged nasal discharge, irregular proliferative growth. 12

13. Treatment Includes intranasal or systemic steroids and Leukotrine inhibitors . A short course of systemic steroids can serve as ‘ medical polypectomy ’. In more severe cases surgery is required, FESS . 13

14. ANTROCHOANAL POLYP Syn Killian’s polyp They are benign polypoid lesions arising from the maxillary antrum and they extend into the choana. A-C Polyps usually have three components Antral Part Nasal Part Choanal Part A-C Polyps are almost always unilateral, although bilateral A -C Polyps have been reported. 14

15. Arises from maxillary and passes through the maxillary ostium into the middle meatus, and then extends towards the nasopharynx / oropharynx. mostly originates from the posterior, inferior, lateral or medial walls of the maxillary antrum . They are most commonly seen in young adults and in 3rd to 5th decades. They are slightly more common in males compared to females. ANTROCHOANAL POLYP 15

16. Endoscopic View 16

17. Symptoms Nasal obstruction Rhinorrhea Snoring Headache Mouth breathing Hyposmia Halitosis Dyspnea Nasal pruritis 18

18. Plain X-ray film Waters View Unilateral opacification of the maxillary sinus Nasopharyngeal mass is occasionally seen Frequently bilateral sinus involvement 19 Investigations

19. Computed Tomography Defined mass with mucin density is seen arising within the maxillary sinus Widening of maxillary ostium and extending in to nasopharynx No associated bony destruction but rather smooth enlargement of sinus 20 Investigations

20. Differential Diagnosis Juvenile angiofibroma Meningoencephalocele Inverted papilloma Mucocele Mucus retention cyst Tornwalt's cyst Grossly enlarged adenoids Lymphoma Nasopharyngeal malignancies 21

21. Treatment The treatment of A-C Polyp is always surgical. Simple polypectomy and for recurrent polyps Caldwell Luc procedure were the previously preferred methods for surgical treatment. In recent years, functional endoscopic sinus surgery (FESS) became the more preferred surgical technique. 22

22. THANK YOU 23