Nasalpolyps

Includes :
-Definition
-Types
-Brief discussion about the types of nasal polyps along with management and treatment

1. NASAL POLYP -Kritika Singh (31)

2. Non-neoplastic masses of oedematous nasal or sinus mucosa.

3. TYPES NASAL POLYPS BILATERAL ETHMOI D AL POLYP ANT R O CH O ANAL POLYP

4. BILATERAL ETHMOIDAL POLYP

5. AETIO LOG Y Inflammatory conditions of nasal mucosa Rhino-sinusitis Disorders of ciliary motility Kartagener syndrome Abnormal composition of nasal mucus Cystic fibrosis

6. Various disease associated with the formation of nasal polyps are : Chronic rhino-sinusitis Kartagener syndrome Cystic fibrosis Asthma Aspirin in tolerance Allergic fungal sinusitis Young syndrome Churg -Strauss syndrome Nasal mastocytosis (chro nic rhinitis)

7. PATHOGENESIS Nasal mucosa becomes oedematous due to collection of ECF polypoidal change Sessile P edunculate (due to gravity and excessive sneezing )

8. PATHOLOGY Early stage Nasal polyp (surface covered by ciliated columnar epithelium ) Transitional & squamous epithelium Submucosa L arge ICS filled with serous fluid + infiltration with eosinophils and round cells Metaplastic change in exposure to atmospheric irritation

9. SITE OF ORIGIN Multiple nasal polyps always arise from the lateral wall of nose, usually from the middle meatus. Common sites : Uncinate process Bulla ethmoidalis Ostia of sinuses Medial surface & edge of middle turbinate

10. SYMPTOMS Nasal stuffiness  leading to total nasal obstruction Partial/total loss of smell Headache (associated sinusitis) Sneezing and watery nasal discharge (associated allergy) Protruding mass

11. SIGNS On anterior rhinoscopy , polyps appear as :- Smooth, glistening Grape-like masses Often pale in color May be sessile or pedunculate Insensitive to probing Do not bleed on touch Often multiple and bilateral Broadening of nose Increase intercanthal distance Polyp may protrude from the nostril and appear pink and vascular, simulating neoplasm Purulent discharge (associated sinusitis) LONG STANDING CASE

12. DIAGNOSIS Clinical examination CT scan of paranasal sinuses exclude neoplasia bony erosion plan surgery Histological examination especially in people >40 years

13. TREATMENT CONSERVATIVE Antihistaminic & control of allergy may revert early polypoidal changes with oedematous mucosa to normal Short course steroids in people who cannot tolerate antihistaminic or with asthma

14. TREATMENT SURGICAL Polypectomy (one or two pedunculated polyps can be removed with snare). Intranasal ethmoidectomy (when polyp are multiple, require uncapping of ethmoidal air cells). Extranasal ethmoidectomy (when margins are ill-defined; medial wall of orbit). Transantral ethmoidectomy (when infection & polypoidal changes are seen in maxillary antrum). Endoscopic sinus surgery

15. ANTROCHOANAL POLYP

16. SITE OF ORIGIN Arise from the mucosa of maxillary antrum near its accessory ostium, comes out of it, and grows in the choana and nasal cavity Thus, it has 3 parts : Antral : thin stalk Choanal : round and globular Nasal : flat from side to side

17. AETIO LOG Y Exact cause is unknown. Nasal allergy coupled with sinus infection is incriminated Seen in children and young adults Usually single and unilateral

18. 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

19. SIGNS Anterior rhinoscopy - may be missed as it grows posteriorly Large , smooth , greyish mass covered with nasal discharge Soft , can be moved up and down with the probe May protrude from nostril – shows pink, congested loop

20. Posterior rhinoscopy Globular mass filling the choana or the nasopharynx A large polyp may hang down behind soft palate and present in oropharynx

21. INVESTIGATIONS Nasal endoscopy May reveal choanal or antrochoanal polyp hidden posteriorly in the nasal cavity X-rays of paranasal sinuses May show opacity of the involved antrum Lateral view x-ray globular swelling in postnasal space column of air behind the polyp

22. DIFFERENTIAL DIAGNOSIS A blob of mucus - disappear on blowing nose Hypertrophied middle turbinate -pink appearance -hard feel of bone on probe testing Angiofibroma -history of profuse recurrent epistaxis - firm in consistency -easily bleed on touch Neoplasms -fleshy pink appearance friable nature tendency to bleed)

23. TREATMENT Avulsion (nasal/oral route) Recurrence is uncommon after complete removal In case of recurrence, Caldwell-Luc operation – Complete removal of polyp from site of origin Endoscopic sinus surgery is now preferred

24. Ethmoidal polyp Antrochoanal polyp Age Common in adults Common in children Etiology Allergy or multifocal Infection Number Multiple Solitary Laterality Bilateral Unilateral Origin Ethmoidal sinuses Maxillary sinus near ostium Growth Mostly anteriorly & may present at the nares Backwards to choana, may hang down behind soft palate Size & shape Usually small & grape-like masses Trilobed (antral, nasal, choanal part) Recurrence Common Uncommon if removed completely Treatment Polypectomy, endoscopic surgery or ethmoidectomy Polypectomy, endoscopic removal

25. THANK YOU!